AUS rule variables and homecare eligibility criteria
| AUS rule | Yes | No | |
| Preceding chemotherapy more intensive than ALL maintenance | 1 | 0 | |
| Total white cell count <0.3×109/L | 1 | 0 | |
| Platelet <50×109/L | 1 | 0 | |
| Minimum observation period (if clinically stable and fulfil homecare criteria) | |||
| AUS=0 | AUS=1 | AUS=2 | AUS=3 |
| 4–8 hours | 4–24 hours | 24 hours | 48 hours |
| Eligibility criteria for homecare | |||
| Disease status: leukaemia/lymphoma in remission (as per last bone marrow aspirate or solid tumour stable/responding (as per oncologist) | |||
| Low-risk disease group: NOT ANY OF—ALL induction, or acute infant leukaemias, acute myeloid leukaemia, postallogeneic haematopoietic stem cell transplant within 3 months or still on immunosupression, congenital immunodeficiency, aplastic anaemia, Down syndrome Centres may have particular local concerns about other specific diagnosis | |||
| No confirmed focus of infection requiring inpatient care* | |||
| No medical complication requiring inpatient care† | |||
| No severe sepsis at FN presentation‡ | |||
| Availability of a 24-hour caregiver | |||
| Good education of patient and carer on reportable symptoms | |||
| Availability of a telephone | |||
| Within 1 hour of treating hospital | |||
| Treating team preference | |||
| No previous history of non-compliance with medical care | |||
Variations may consider excluding ANY patient who has received a fluid bolus, or had a past unplanned admission to ICU. If well, presence of infiltrates on CXR may not be a contraindication to oral antibiotic therapy.
At the time of writing, SARS-CoV2/COVID-19-positive swabs should NOT NECESSARILY be a contraindication to homecare.
*Including, but not limited to, central venous access device site infection, cellulitis, perianal cellulitis or pain, significant pneumonia, infection with multidrug-resistant bacteria.
†Including, but not limited to, pain requiring intravenous analgesia, poor oral intake or excessive loss requiring intravenous hydration; respiratory distress or oxygen requirement.
‡Severe sepsis includes any of (i) altered conscious state, (ii) inotrope requirement, (iii) fluid bolus requirement >40 mL/kg or (iv) respiratory support requirement.
ALL, acute lymphoblastic leukaemia; AUS, Australian-UK-Swiss; CXR, chest X-ray; FN, febrile neutropenia; ICU, intensive care unit.