Archives of disease in childhood · 2022
Can I go home now? The safety and efficacy of a new UK paediatric febrile neutropenia protocol for risk-stratified early discharge on oral antibiotics.
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Jackson Thomas John, Napper Rachel, Haeusler Gabrielle M, Pizer Barry, Bate Jessica, Grundy Richard G, Samarasinghe Sujith, Angelini Paola, Ball-Gamble Ashley, Phillips Bob, Morgan Jessica Elizabeth
Аннотация
OBJECTIVE: To evaluate a new protocol of risk stratification and early discharge for children with febrile neutropenia (FN).
DESIGN: Prospective service evaluation from 17 April 2020 to 16 April 2021.
SETTING: 13 specialist centres in the UK.
PATIENTS: 405 children presenting with FN.
INTERVENTION: All children received intravenous antibiotics at presentation. Risk stratification was determined using the Australian-UK-Swiss (AUS) rule and eligibility for homecare assessed using criteria including disease, chemotherapy, presenting features and social factors. Those eligible for homecare could be discharged on oral antibiotics after a period of observation proportional to their risk group.
MAIN OUTCOME MEASURES: Median duration of admission and of intravenous antibiotics, and percentage of patients with positive blood cultures, significant infection, readmission within 7 days of initial presentation, intensive care unit (ICU) admission, death from infection and death from other causes.
RESULTS: 13 centres contributed 729 initial presentations of 405 patients. AUS rule scores were positively correlated with positive blood cultures, significant infection, ICU admission and death. 20% of children were eligible for homecare with oral antibiotics, of which 55% were low risk (AUS 0-1). 46% low-risk homecare eligible patients were discharged by 24 hours vs 2% homecare ineligible. Homecare readmission rates were 14% overall and 16% for low-risk cases (similar to a meta-analysis of previous studies). No child eligible for homecare was admitted to ICU or died.
CONCLUSIONS: Use of the AUS rule and homecare criteria allow for safe early outpatient management of children with FN.
DESIGN: Prospective service evaluation from 17 April 2020 to 16 April 2021.
SETTING: 13 specialist centres in the UK.
PATIENTS: 405 children presenting with FN.
INTERVENTION: All children received intravenous antibiotics at presentation. Risk stratification was determined using the Australian-UK-Swiss (AUS) rule and eligibility for homecare assessed using criteria including disease, chemotherapy, presenting features and social factors. Those eligible for homecare could be discharged on oral antibiotics after a period of observation proportional to their risk group.
MAIN OUTCOME MEASURES: Median duration of admission and of intravenous antibiotics, and percentage of patients with positive blood cultures, significant infection, readmission within 7 days of initial presentation, intensive care unit (ICU) admission, death from infection and death from other causes.
RESULTS: 13 centres contributed 729 initial presentations of 405 patients. AUS rule scores were positively correlated with positive blood cultures, significant infection, ICU admission and death. 20% of children were eligible for homecare with oral antibiotics, of which 55% were low risk (AUS 0-1). 46% low-risk homecare eligible patients were discharged by 24 hours vs 2% homecare ineligible. Homecare readmission rates were 14% overall and 16% for low-risk cases (similar to a meta-analysis of previous studies). No child eligible for homecare was admitted to ICU or died.
CONCLUSIONS: Use of the AUS rule and homecare criteria allow for safe early outpatient management of children with FN.