RT Journal Article
SR Electronic
T1 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
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 192
OP 197
DO 10.1136/archdischild-2021-323254
VO 108
IS 3
A1 Thomas John Jackson
A1 Rachel Napper
A1 Gabrielle M Haeusler
A1 Barry Pizer
A1 Jessica Bate
A1 Richard G Grundy
A1 Sujith Samarasinghe
A1 Paola Angelini
A1 Ashley Ball-Gamble
A1 Bob Phillips
A1 Jessica Elizabeth Morgan
YR 2023
UL http://adc.bmj.com/content/108/3/192.abstract
AB 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.Data are available on reasonable request. Requests to access pseudoanonymised data shall be addressed to TJJ.