title: Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department.
abstract: OBJECTIVE
  Although validated risk-stratification tools have been used to send low-risk febrile neutropenic patients home from clinic and inpatient settings, there is a dearth of research evaluating these scores in the emergency department (ED). We compare the predictive accuracy of the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores for patients with chemotherapy-induced febrile neutropenia and presenting to the ED.
  
  
  METHODS
  We conducted a retrospective cohort study to evaluate all patients with febrile neutropenia (temperature ≥38°C [100.4°F], absolute neutrophil count <1,000 cells/μL) who presented to 2 academic EDs from June 2012 through January 2015. MASCC and CISNE scores were calculated for all subjects, and each visit was evaluated for several outcome variables, including inpatient length of stay, upgrade in level of care, clinical deterioration, positive blood culture results, and death. Descriptive statistics are reported and continuous variables were analyzed with Wilcoxon rank sum.
  
  
  RESULTS
  During our study period, 230 patients presented with chemotherapy-induced febrile neutropenia. The CISNE score identified 53 (23%) of these patients as low risk and was highly specific in the identification of a low-risk cohort for all outcome variables (98.3% specific, 95% confidence interval [CI] 89.7% to 99.9%; positive predictive value 98.1%, 95% CI 88.6% to 99.9%). Median length of stay was shorter for low-risk versus high-risk CISNE patients (3-day difference; P<.001). The MASCC score was much less specific (54.2%; 95% CI 40.8% to 67.1%) in the identification of a low-risk cohort.
  
  
  CONCLUSIONS
  Our results suggest that the CISNE score may be the most appropriate febrile neutropenia risk-stratification tool for use in the ED.
authors.affiliation: Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego, CA. Electronic address: cjcoyne@ucsd.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Coyne
authors.affiliation: Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego, CA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Le
authors.affiliation: Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego, CA.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Brennan
authors.affiliation: Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego, CA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Castillo
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, University of California San Diego School of Medicine, La Jolla, CA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Shatsky
authors.affiliation: Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA.
authors.forename: Karen
authors.initials: K
authors.lastname: Ferran
authors.affiliation: Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brodine
authors.affiliation: Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego, CA.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D019540:Area Under Curve; D004636:Emergency Service, Hospital; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents