SAFETY AND COST-EFFECTIVENESS OF EARLY HOSPITAL DISCHARGE OF LOWER RISK CHILDREN WITH CANCER ADMITTED FOR FEVER AND NEUTROPENIA

Background. Standard treatment for fever during periods of chemotherap y-induced neutropenia includes hospitalization and administration of i ntravenous antibiotics until the patient is afebrile and no longer neu tropenic. This study prospectively evaluates the safety and cost-effec tiveness of early discharge of selected low risk children before recov ery from neutropenia. Methods. We studied 74 children with cancer duri ng 131 consecutive admissions for fever during a period of neutropenia . All patients initially were hospitalized and received broad-spectrum antibiotics. Intravenous antibiotic therapy was discontinued, and the patients promptly were discharged even if they had an absolute neutro phil count (ANC) of less than 500 cells/mm(3) as long as they were afe brile, appeared clinically well, had negative cultures, exhibited cont rol of local infection, and showed hematologic evidence of bone marrow recovery. Results. Intravenous antibiotics were discontinued in 82 ca ses (63%) before recovery of the ANC to more than 500 cells/mm(3), and 78 patients were discharged immediately. None of 70 patients discharg ed while neutropenic but exhibiting a rising ANC at the time of discha rge developed recurrent fever and required readmission. Thirty of thes e children had an improving localized infection when intravenous antib iotics were discontinued and completed a course of oral antibiotics at home. The estimated mean savings in hospital charges due to early dis charge was $5058 per patient. Conclusions. Low risk children with canc er who are hospitalized and treated for fever and neutropenia but appe ar clinically well may have intravenous antibiotics discontinued and b e discharged safely irrespective of the ANC, as long as their granuloc yte count is rising. This approach shortens hospital stays and results in considerable cost savings.