Department of Acute Medicine and Critical Care, The Christie, Manchester, United Kingdom.
J Emerg Med. 2020 Mar;58(3):444-448. doi: 10.1016/j.jemermed.2019.09.032. Epub 2019 Nov 16.
Emergency patient presentations with febrile neutropenia are a heterogeneous group. A small minority of these patients proceed to develop significant medical complications. Risk stratification using scores, such as the Multinational Association for Supportive Care in Cancer score, have been advocated to identify patients who are at low risk of adverse outcome suitable for treatment on an ambulatory care pathway.
We sought to report the experience of 100 patients presenting acutely with neutropenic fever managed in an emergency ambulatory fashion.
Patients presenting as an emergency with low-risk febrile neutropenia managed in an ambulatory setting between January 2017 and February 2019 at a tertiary cancer hospital in England were prospectively studied. Patients with a fever >38.0°C and an absolute neutrophil count <1.0 × 10/L were included. All patients with a Multinational Association for Supportive Care in Cancer score ≥21 and a National Early Warning Score ≤3 were potentially eligible for the pathway. Complications were classified as serious if the patient developed persistent hypotension, respiratory failure, intensive care unit admission, altered mental status, disseminated intravascular coagulation, renal failure requiring renal replacement therapy, electrocardiogram changes requiring antidysrhythmic treatment, and 30-day mortality.
One hundred patients with low-risk febrile neutropenia consecutively managed in an emergency ambulatory fashion were prospectively analyzed. Eighty-one patients were female and the median age was 51 y (range 17-79 y). No patients developed serious complications. Eight (8% [95% confidence interval 4.1-15.0%]) patients had a 7-day readmission.
Outpatient ambulatory care for emergency patients with low-risk febrile neutropenia can be delivered in a safe and effective fashion. Collaboration between acute care physicians and oncologists is required to develop local models based on national guidelines to facilitate individualised care for emergency oncology patients.
伴有发热性中性粒细胞减少症的急诊患者表现出异质性。其中一小部分患者会出现严重的医疗并发症。使用评分（如多国癌症支持协会评分）进行风险分层，以识别出低风险不良预后的患者，适合在门诊护理途径中进行治疗。
我们报告了在英国一家三级癌症医院以急诊门诊方式管理的 100 例急性中性粒细胞减少性发热患者的经验。
2017 年 1 月至 2019 年 2 月期间，对在英国一家三级癌症医院以急诊方式就诊且处于低危状态的发热性中性粒细胞减少症患者进行前瞻性研究。纳入标准为发热>38.0°C 且绝对中性粒细胞计数<1.0×10/L 的患者。所有 Multinational Association for Supportive Care in Cancer 评分≥21 且 National Early Warning Score ≤3 的患者均有资格进入该途径。如果患者出现持续性低血压、呼吸衰竭、入住重症监护病房、意识改变、弥漫性血管内凝血、需要肾脏替代治疗的肾衰竭、需要抗心律失常治疗的心电图改变以及 30 天死亡率，则将并发症分类为严重。
连续以急诊门诊方式管理的 100 例低危发热性中性粒细胞减少症患者进行了前瞻性分析。81 例为女性，中位年龄为 51 岁（范围 17-79 岁）。无患者发生严重并发症。8 例（8%[95%置信区间 4.1-15.0%]）患者在 7 天内再次入院。
以低危发热性中性粒细胞减少症的急诊患者进行门诊治疗可以安全有效地进行。需要急性护理医生和肿瘤学家之间的合作，根据国家指南制定本地模式，为急诊肿瘤患者提供个体化护理。
