Can I go home now? The safety and efficacy of a new UK paediatric febrile neutropenia protocol for risk-stratified early discharge on oral antibiotics.
Arch Dis Child
; 108(3): 192-197, 2023 03.
Artículo
en Inglés
| MEDLINE | ID: covidwho-2264240
ABSTRACT
OBJECTIVE:
To evaluate a new protocol of risk stratification and early discharge for children with febrile neutropenia (FN).DESIGN:
Prospective service evaluation from 17 April 2020 to 16 April 2021.SETTING:
13 specialist centres in the UK. PATIENTS 405 children presenting with FN. INTERVENTION All children received intravenous antibiotics at presentation. Risk stratification was determined using the Australian-UK-Swiss (AUS) rule and eligibility for homecare assessed using criteria including disease, chemotherapy, presenting features and social factors. Those eligible for homecare could be discharged on oral antibiotics after a period of observation proportional to their risk group. MAIN OUTCOMEMEASURES:
Median duration of admission and of intravenous antibiotics, and percentage of patients with positive blood cultures, significant infection, readmission within 7 days of initial presentation, intensive care unit (ICU) admission, death from infection and death from other causes.RESULTS:
13 centres contributed 729 initial presentations of 405 patients. AUS rule scores were positively correlated with positive blood cultures, significant infection, ICU admission and death. 20% of children were eligible for homecare with oral antibiotics, of which 55% were low risk (AUS 0-1). 46% low-risk homecare eligible patients were discharged by 24 hours vs 2% homecare ineligible. Homecare readmission rates were 14% overall and 16% for low-risk cases (similar to a meta-analysis of previous studies). No child eligible for homecare was admitted to ICU or died.CONCLUSIONS:
Use of the AUS rule and homecare criteria allow for safe early outpatient management of children with FN.Palabras clave
Texto completo:
Disponible
Colección:
Bases de datos internacionales
Base de datos:
MEDLINE
Asunto principal:
Neutropenia Febril
/
Neoplasias
Tipo de estudio:
Estudio de cohorte
/
Estudio experimental
/
Estudio observacional
/
Estudio pronóstico
/
Ensayo controlado aleatorizado
/
Revisiones
Límite:
Niño
/
Humanos
País/Región como asunto:
Europa
/
Oceanía
Idioma:
Inglés
Revista:
Arch Dis Child
Año:
2023
Tipo del documento:
Artículo
País de afiliación:
Archdischild-2021-323254
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