The risk of a patient with neutropenic fever experiencing medical complications should be assessed using an accepted risk assessment tool. Evidence supports the using the MASCC (Multinational Association for Supportive Care in Cancer) risk index as the preferred risk assessment tool,r which has been validated in patients with solid tumours and patients with haematological malignancy.
This tool can be used to identify low-risk patients (score greater than or equal to 21 points) for serious complications of febrile neutropenia (including death, intensive care unit admission, confusion, cardiac complications, respiratory failure, renal failure, hypotension, bleeding, and other serious medical complications). The score was developed to select patients for therapeutic strategies that could potentially be more convenient or cost-effective. Clinically stable patients that are classified as high-risk by the MASSC score are to receive inpatient parenteral beta-lactam monotherapy, as per flow diagram above.
MASCC index score for identifying low-risk patients with neutropenic fever*
Characteristic |
Point score |
Burden of illness
- No or mild symptoms
- Moderate symptoms
|
5
3 |
No hypotension |
5 |
No chronic obstructive pulmonary disease |
4 |
Solid tumour or no previous fungal infection** |
4 |
Outpatient status*** |
3 |
No dehydration |
3 |
Aged < 60 years |
2 |
© Internal Medicine Journal 2011r
|
* The maximum value in this system is 26. A score of > 21 predicts a < 6% risk for severe complications and a very low mortality (< 1%) in neutropenic febrile patients.
** Previous fungal infection: means demonstrated fungal infection or empirically treated suspected fungal infection.
*** Outpatient status: means onset of fever as an outpatient.
|