| Study ID | Population | Cancer | Study period | Episodes febrile neutropenia | Number of patients | Criteria for discharge | No. meeting basic criteria for early discharge | No. discharged early | Hospital re-admission in early discharge group | Death in early discharge group |
|---|---|---|---|---|---|---|---|---|---|---|
| Randomised Controlled trials | ||||||||||
| 1. Innes 2003 | Adult | Haematologic and solid malignancies | 1997-2000 | 102 | 126 | Anticipated duration of neutropenia < 7 days Haemodynamically stable No signs or symptoms that required IV fluid support Adequate renal function Ability to maintain satisfactory oral intake Living with responsible adult prepared to act as a carer Patient or carer able to read a thermometer | N.A. | N.A. | 5 (13%) | 0 (0%) |
| 2. Santolaya 2004 | Paediatric | Haematologic and solid malignancies | 2000 -2003 | 390 | 390 | Serum C-reactive protein (CRP) levels lower 90 mg/L No hypotension No relapse of leukaemia as cancer type Platelet count of more than 50,000/μL No recent (≤ 7 days) chemotherapy | N.A. | N.A. | Not reported | 0 (0%) |
| Open un-randomised comparative study | ||||||||||
| 3. Lau 1994 | Paediatric | 1990-1991 | 21 | 23 | Negative blood culture | N.A. | 11 (only considered low risk patients) | Not reported by group | 0 (0%) | |
| Prospective case series | ||||||||||
| 4. Cherif 2006 | Adult | Haematologic malignancies | 2003-2005 | 279 | 191 | MASCC (score ≥ 21) Afebrile for 24 hours Discharged with oral antibiotics | 105 (38%) | 67 (24%) | 3 (4%) | 0 (0%) |
| 5. Girmenia 2007 | Adult | Haematologic malignancies | 2001-2002 | 100 | 87 | MASCC (score ≥ 21) Afebrile for 48 hours Discharged with oral antibiotics | 90 (90%) | 69 (69%) | 2 (3%) | 0 (0%) |
| 6. Klastersky 2006 | Adult | Haematologic and solid malignancies | 1999-2003 | 611 | 441 | MASCC (score ≥ 21) Hospitalised for minimum of 24 hours Discharged with oral antibiotics | 383 (63%) | 79 (13%) | 3 (4%) | 0 (0%) |
| 7. Nijhuis 2005 | Adult and Paediatric | Haematologic and solid malignancies | 1999-2002 | 196 | 128 | No local bacterial infection / abnormal vital signs (systolic blood pressure less than 99 mmHg, or both heart rate higher than 100/min in adults or less than -2SD for age in children and respiratory rate higher than 20/min in adults or both heart and respiratory rate higher than +2 SD for age in children suggesting sepsis. Interleukin 8 level below cut off value of 60 ng/L Antibiotics completely withheld. Afebrile for 12 hours | 36 (18%) | 36 (18%) | 0 (0%) | 0 (0%) |
| 8. Dommett 2009 | Paediatric | Haematologic and solid malignancies | 2004-2005 | 762 | 368 | Excluded from low risk protocol if: Age<1 year, shock/ compensated shock, haemorrhage, dehydration, metabolic instability, altered mental status, pneumonitis, mucositis, respiratory distress/ compromise, peri-rectal / other soft tissue abscess, rigors, irritability/meningism, organ failure, acute lymphoblastic leukaemia at diagnosis/relapse <28 d, acute lymphoblastic leukaemia not in remission >28 d acute myeloid leukaemia, infant acute lymphoblastic leukaemia, intensive B-NHL protocols, haemopoietic stem cell transplant, sequential high dose chemotherapy with PBSC rescue, intensive care admission during last FN episode, non adherence (social concerns or patient), inability to tolerate oral antibiotics, positive blood culture result at 48 h, ANC < 0.1 · 109/L at 48 h, child not clinically well at 48 h (clinician judgement). Hospitalised for minimum of 48 hours Discharged with oral antibiotics | 212 (27%) | 143 (19%) | 8 (6%) | 0 (0%) |
| 9. Lehrnbecher 2002 | Paediatric | Haematologic and solid malignancies | 1994-1996 | 106 | 56 | Patients were not formally categorised as high / low risk. Were eligible for discharge when following criteria met: good clinical condition, negative blood culture results, no infectious focus, absence of fever for at least 24 hrs. Early discharge only allowed in cases of fever of unknown origin Hospitalised for minimum of 72 hours. Afebrile for 24 hours. Antibiotics ceased before discharge | N/A | 24 (23%) | 0 (0%) | 0 (0%) |
| 10. Bash 1994 | Paediatric | Haematologic and solid malignancies | 1989-1990 | 131 | 74 | Appeared clinically well Negative blood cultures Exhibited control of local infection Hematologic evidence of bone marrow recovery Antibiotics ceased before discharge | 82 (63%) | 78 (58%) | 7 (9%)* *these patients said to violate the early discharge protocol | 0 (0%) |
| Retrospective case series | ||||||||||
| 11. Tordecilla 1994 | Paediatric | Solid malignancies | 1992-1993 | 84 | 50 | *retrospective analysis, patients were not prospectively assigned to low/high risk groups Appeared well Negative blood cultures Normal chest x-ray Afebrile Discharged with/ without antibiotics | N.A. | 30 (35.7%) | 0 (0%) | 0 (0%) |
| 12. Aquino 1997 | Paediatric | Haematologic and solid malignancies | 1992 -1995 | 580 | 253 | *retrospective analysis, patients were not prospectively assigned to low/high risk groups Clinically well appearance Sterility of all blood cultures Control of local infection with antibiotic therapy (defined as reduction or resolution of local signs of inflammation such as erythema, induration and tenderness) Evidence of bone marrow recovery (defined as any sustained increase in platelet count and ANC or APC) Afebrile for 24 hours Discharged with/without oral antibiotics | N.A. | 330 (57%) | 21 (6%) | 0 (0%) |
| 13. Mullen 1990 | Paediatric | Haematologic and solid malignancies | 1988-1999 | 114 | 61 | *retrospective analysis, patients were not prospectively assigned to low/high risk groups Negative blood cultures (Usually) some evidence of bone-marrow recovery Afebrile for 1-2 days | N.A. | 77 (68%) | 3 (3.9%) | 0 (0%) |
| 14. Griffin 1992 | Paediatric | Haematologic and solid malignancies | 1989 | 107 | 64 | Initial blood cultures were sterile after 48 hours Appeared well Any identified infection is under control Afebrile for 24 hours | N.A | 70 (65%) | 1/70 (1%) | 0 (0%) |
| 15. Wacker 1997 | Paediatric | Haematologic and solid malignancies | 1992-1995 | 88 | 30 | *retrospective analysis, patients were not prospectively assigned to low/high risk groups No documented infection (no pathogenic organisms identified on cultures) throughout hospital course Normal physical exam Afebrile for 24 hours | 44 (50%) | 25 (28%) | 2 (8%) | 0 (0%) |
| 16. Hodgson-Viden 2005 | Paediatric | Haematologic and solid malignancies | 1997 -2002 | 276 | 127 | *retrospective analysis, patients were not prospectively assigned to low/high risk groups No formal criteria for early discharge. Decision based solely on clinician's judgement. Patients were discharged on the day intravenous antimicrobial therapy (IVAMT) was ceased. Early discharge was defined as discontinuation of IVAMT with an ANC ≤ 500/mm3. | N.A. | 112 (41%) | 0 (0%) | 0 (0%) |
| 17. Tomiak 1994 | Adult | Haematologic and solid malignancies | 1991-1993 | 134 | 134 | *retrospective analysis, patients were not prospectively assigned to low/high risk groups Negative blood cultures Afebrile and clinically stable for 48 hours | N.A. | 37 (28%) | 2 (5%) | 1 (3%) |
| 18. Santos-Muchado 1999 | Paediatric | Haematologic and solid malignancies | 1996 | 79 | 46 | Negative blood cultures Afebrile for 24 hours Discharged with oral antibiotics (in most cases) | N.A. | 34 (43%) | Not reported | 0 (0%) |
From: Subsequent Treatment: guideline chapter seven
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