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
