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Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy

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Table 1. Additional Specific Clinical Criteria a That May Be Used to Exclude Oncology Patients Who Have Fever and Neutropenia from Initial Outpatient Care Even with a MASCC Score ≥21 Cardiovascular • presyncope/witnessed syncope • accelerated hypertension • new onset or worsening of hypotension • uncontrolled heart failure, arrhythmias, or angina • clinically relevant bleeding • pericardial effusion Hematologic • severe thrombocytopenia (platelets <10,000/µL) • anemia (Hb <7 g/dL or Hct <21%) • ANC <100/µL of expected duration ≥7 days • deep venous thrombosis or pulmonary embolism Gastrointestinal • unable to swallow oral medications • new onset or clinically relevant worsening of diarrhea • melena, hematochezia (hemorrhoid-unrelated), or hematemesis • abdominal pain • ascites Hepatic • impaired hepatic function (aminotransferase values >5 times ULN) or clinically relevant worsening of aminotransferase values • bilirubin >2.0 mg/dL or clinically relevant increase in bilirubin Infectious • presence of a clear anatomical site of infection — e.g. symptoms of pneumonia, cellulitis, abdominal infection, abnormal imaging or microbial laboratory cultures b • any evidence of severe sepsis c • allergies to antimicrobials used for outpatients • antibiotics ≤72 hours before presentation • intravascular catheter infection Neurological • altered mental status/sensorium or seizures • presence or concern for CNS infection or non-infectious meningitis • presence or concern for spinal cord compression • new or worsening neurologic deficit Pulmonary/ orax • tachypnea or hypopnea • hypoxemia, hypercarbia • pneumothorax or pleural effusion • presence of cavitary lung nodule or imaging findings suggestive of an active intra-thoracic process Identification of Candidates for Outpatient Management

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