Patient selection:
(1) hematological or solid malignancy
(2) febrile (single measurement >= 38.5°C or >=2 measurements >= 38°C within a 12 hour period)
(3) neutropenia with absolute neutrophil count < 1,000 per µL and expected to decrease to < 500 per µL in 23-48 hours
(4) episode of primary infection responding to antibiotic therapy (>= 4 days without fever)
Parameters:
(1) age
(2) type of cancer
(3) intravenous line
(4) degree of neutropenia
(5) documentation of primary infection
|
Parameter
|
Finding
|
Points
|
|
age of the patient
|
<= 16 years of age
|
0
|
|
|
> 16 years of age
|
1
|
|
type of cancer
|
acute leukemia during first induction
|
1
|
|
|
other
|
0
|
|
intravenous line
|
absent
|
0
|
|
|
present
|
1
|
|
degree of neutropenia
|
mild to moderate (>= 100 per µL)
|
0
|
|
|
severe (< 100 per µL)
|
1
|
|
documentation of primary infection
|
microbiological (positive culture)
|
1
|
|
|
clinical
|
0
|
|
|
fever of unknown origin
|
1
|
total number of risk factors for secondary infection =
= SUM(points for all 5 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• The presence of more risk factors for secondary infections increased the risk for one or more secondary infection.
The risk of death if a secondary infection developed was 5.4% vs 1.4% if there were no secondary infection (4-fold difference).
