Assessment
Table 4. Additional Specific Clinical Criteria
a
that Exclude
Oncology Patients with Fever and Neutropenia
from Initial Outpatient Care even if in Talcott's Group
4 or 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
• Intractable nausea and/or vomiting
• New onset or clinically relevant worsening of diarrhea
• Melena, hematochezia (non-hemorrhoidal), or hematemesis
• Abdominal pain
• Ascites
Hepatic • Impaired hepatic function (aminotransferase values >5x ULN) or
clinically relevant worsening of aminotransferase values
• Bilirubin >2.0 or clinically relevant increase in bilirubin
Infectious • Presence of a clear anatomical site of infection, eg, symptoms of
pneumonia, cellulitis, abdominal infection, positive imaging, or
microbial laboratory findings
b
• Any evidence of severe sepsis
c
• Allergies to antimicrobials used for outpatients
• Antibiotics ≤72 hours before presentation
• Intravascular catheter infection
Neurologic • 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/
thorax
• Tachypnea or hypopnea
• Hypoxemia, hypercarbia
• Pneumothorax or pleural effusion
• Presence of cavitary lung nodule or imaging findings suggestive of an
active intra-thoracic process
