NOTE: These criteria share features with the criteria of Rolston et al and of the IDSA (above).
Patient selection: child with cancer
Outcome: bacteremia or serious medical complication
Neutropenia was defined as an absolute neutrophil count < 500 per µL at the time of initial evaluation.
Fever was defined as a single temperature > 38.5°C.
A child was classified as low risk if all of the following are present:
(1) neutropenia was anticipated to last less than 7 days
(2) outpatient
(3) no significant comorbidity at presentation (see below)
(4) cancer diagnosis is NOT (a) acute myelogenous leukemia (AML), (b) acute lymphoblastic leukemia (ALL) in the induction phase of therapy, (c) Burkitt's lymphoma or (d) relapsed or progressive disease involving the bone marrow (uncontrolled cancer)
Any patient not low risk was classified as high risk.
The risk of significant adverse event in the low risk group was 4% vs 41% in the high risk group.
Significant comorbidities include:
(1) hypotension
(2) chest X-ray shows a new pulmonary infiltrate
(3) abdominal pain and/or vomiting
(4) mucositis with severe pain requiring intravenous narcotics
(5) alerted mental status
(6) tachypnea
(7) hypoxia (oxygen saturation < 94% on room air)
(8) tunnel infection, cellulitis, perirectal abscess or other significant local infection
(9) any condition requiring inpatient management
