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
Renal • impaired renal function (creatinine clearance ≤30 mL/min)
or oliguria or clinically relevant worsening renal function (as
determined by the treating physician)
• new onset of gross hematuria
• urinary obstruction or nephrolithiasis
• clinically relevant dehydration
• clinically relevant electrolyte abnormalities, acidosis or alkalosis
(requiring medical intervention)
Other
significant
comorbidity
• presence of a major abnormality in regard to: organ dysfunction,
comorbid conditions, vital signs, clinical signs or symptoms,
laboratory data or imaging data
• any relevant clinical worsening (as determined by the treating
physician) of: organ dysfunction, comorbid condition, vital signs,
clinical signs or symptoms, laboratory data or imaging data
• physically or medically frail (as determined by the treating physician)
• pregnant or nursing
• need for IV pain control
• fractures, injuries or the need for emergent radiation therapy
a
Caveat: is is not a comprehensive list and does not replace the need for clinical judgment while
making decisions on outpatient versus inpatient management of FN for individual patients.
b
New onset of minimal symptoms of urinary tract infection and sinusitis may be excluded from this
requirement in most settings with neutropenia <7 days and absence of fungal infection.
c
Severe sepsis is a syndrome defined by the presence of evidence for Systemic Inflammatory Response
Syndrome (SIRS, defined by 2 or more of the following criteria: body temperature >38°C or <36°C;
heart rate >90 beats/min; respiratory rate >20/min; PaCO
2
<32 mmHg ; or an alteration in the
total leukocyte count to >12×10
9
/L or <4×10
9
/L; or the presence of >10% band neutrophils in the
leukocyte differential), plus evidence of infection, plus evidence of end-organ dysfunction (altered
mental status, hypoperfusion [itself defined by hypotension (systolic blood pressure <90 mmHg,
mean arterial pressure <70 mmHg, systolic blood pressure decrease of >40 mmHg, or <2 standard
deviations below the mean for age), by an elevated serum lactate >4mmol/L, or oliguria (urine output
<0.5 ml/kg/hr)] and/or hypoxia PaCO
2
(cont'd)
