Paediatric Oncology, University College London Hospital, London, UK
UCL Great Ormond Street Institute of Child Health, London, UK.
Arch Dis Child. 2023 Mar;108(3):192-197. doi: 10.1136/archdischild-2021-323254. Epub 2022 Dec 12.
To evaluate a new protocol of risk stratification and early discharge for children with febrile neutropenia (FN).
Prospective service evaluation from 17 April 2020 to 16 April 2021.
13 specialist centres in the UK.
405 children presenting with FN.
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.
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.
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.
Use of the AUS rule and homecare criteria allow for safe early outpatient management of children with FN.
评估一种新的发热性中性粒细胞减少症（FN）患儿危险分层和早期出院方案。
2020 年 4 月 17 日至 2021 年 4 月 16 日的前瞻性服务评估。
英国 13 个专科中心。
405 例 FN 患儿。
所有患儿均在就诊时接受静脉内抗生素治疗。采用澳大利亚-英国-瑞士（AUS）规则进行危险分层，并根据疾病、化疗、就诊特征和社会因素等标准评估居家护理的资格。符合居家护理条件的患儿可在观察期后（根据其风险组而定）转为口服抗生素治疗。
中位住院时间、静脉用抗生素时间，以及血培养阳性、有显著感染、初始就诊后 7 天内再入院、入住重症监护病房（ICU）、感染相关死亡和其他原因死亡的患者比例。
13 个中心共收治 405 例患儿的 729 例初始就诊。AUS 评分与血培养阳性、有显著感染、入住 ICU 和死亡均呈正相关。20%的患儿符合居家护理条件，可予口服抗生素治疗，其中 55%为低危（AUS 0-1）。46%的低危居家护理合格患儿在 24 小时内出院，而不合格患儿为 2%。整体居家护理再入院率为 14%，低危病例为 16%（与以往研究的荟萃分析相似）。无符合居家护理条件的患儿入住 ICU 或死亡。
使用 AUS 评分和居家护理标准可安全地对 FN 患儿进行早期门诊管理。
