Patient selection: febrile neutropenia
Outcomes:
(1) invasive bacterial infection or culture-negative sepsis
(2) clinical complications (altered mental status, cardiac arrhythmia, new ECG change, bleeding resulting in transfusion, CHF, DIC, hypotension, admission to ICU, organ failure)
Parameters:
(1) underlying cancer diagnosis
(2) clinical appearance
(3) temperature at presentation in °C
(4) absolute neutrophil count (ANC) per microliter
(5) prior relapse
(6) race
|
Parameter
|
Finding
|
Points for Infection
|
Points for Complications
|
|
cancer diagnosis
|
AML
|
20
|
11
|
|
|
ALL or lymphoma
|
7
|
0
|
|
|
solid tumor
|
0
|
0
|
|
appearance
|
sick or toxic
|
14
|
20
|
|
|
well
|
0
|
0
|
|
temperature
|
< 39°C
|
0
|
0
|
|
|
>= 39°C
|
11
|
0
|
|
ANC
|
< 100
|
10
|
0
|
|
|
>= 100
|
0
|
0
|
|
prior relapse
|
no
|
0
|
0
|
|
|
yes
|
0
|
11
|
|
race
|
white
|
0
|
0
|
|
|
non-white
|
0
|
8
|
total score for infection =
= SUM(points for all of the parameters)
total score for complications =
= SUM(points for all of the parameters)
Interpretation:
• minimum scores: 0
• maximum score for infection: 55
• maximum score for complications: 50
• A score for infection < 24 is associated with low risk.
• A score for complications < 19 is associated with low risk.
Performance:
• The area under the ROC curve for infection is 0.78.
• The area under the ROC curve for complications is 0.80.
