Neutropénie fébrile aux urgences, stratification du risque et conditions du retour à domicile
(2019) Annales françaises de médecine d’urgence — Vol. 9, n° 3, p. 173-183 (2019)
Files
2019_Jacquet_Ann_Fr_Med_Urgence.pdf
Open Access - Adobe PDF
- 179.83 KB
Details
- Authors
- Abstract
- (en) [Febrile Neutropenia in the Emergency Department, Risk Stratification and Terms for Outpatient Management] Febrile neutropenia is a commonly encountered complication in the emergency department (ED) with a mortality rate from 5 to 40%. This significant variability highlights the importance of stratifying risk to allow oral outpatient treatment of some low-risk patients. Besides the MASCC (The Multinational Association for Supportive Care in Cancer) score, other tools allow to evaluate this risk or are under study for this purpose such as the assay of c-reactive protein (CRP), procalcitonin or the CISNE (Clinical index of stable febrile neutropenia) score. After the quick administration of an adequate treatment, the emergency physician may consider outpatient management with oral antibiotics. The combination of amoxicillin/clavulanic acid and ciprofloxacin is most often recommended but moxifloxacin or levofloxacin monotherapy may also be used for outpatient treatments. Returning home can greatly reduce the costs incurred by hospitalization, reduce the risk of nosocomial infection and improve the quality of life of patients with low-risk febrile neutropenia. To this purpose, a few criteria must be met and a talk with the patient is predominant in this decision-making process. In particular, we will consider a MASCC score > 21, an expected duration of neutropenia < 7 days, the agreement of the patient and those around him, as well as the proximity of the home to an adapted care service.
- Affiliations
Citations
Jacquet, J., Catala, G., Machiels, J.-P., & Penaloza-Baeza, A. (2019). Neutropénie fébrile aux urgences, stratification du risque et conditions du retour à domicile. Annales françaises de médecine d’urgence, 9(3), 173-183. https://doi.org/10.3166/afmu-2019-0133 (Original work published 2019)