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 (continued)
Renal • Impaired renal function (creatinine clearance ≤30 mL/min), oliguria,
or clinically relevant worsening of 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
• Pregnant or nursing
• Need for IV pain control
• Fractures, injuries, or need for emergent radiation therapy
a
Caveat: This is not a comprehensive list. Less severe clinical conditions or abnormalities may require
hospitalizations as suggested in the full guideline's text and summary. This list 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 of the following criteria:
• Body temperature >38°C or <36°C
• Heart rate >90 beats/min
• Respiratory rate >20/min
• Pa CO2 <32 mmHg
• An alteration in the total leukocyte count to >12x10
9
/L or <4x10
9
/L
• >10% band neutrophils in the leukocyte differential, plus evidence of infection, plus evidence of end-
organ dysfunction:
▶ Altered mental status
▶ Hypoperfusion/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
» Elevated serum lactate >4 mmol/L
» Oliguria (urine output <0.5 mL/kg/hr)
» Hypoxia
