EARLY DISCHARGE OF LOW-RISK FEBRILE NEUTROPENIC CHILDREN AND ADOLESCENTS WITH CANCER

During the past decade, a relatively lower-risk patient population of febrile neutropenic children with cancer (over one-half of all these p atients) has been identified. These patients can be safely discharged from the hospital before their absolute neutrophil count (ANC) exceeds 500/mm(3). To evaluate the practice of early discharge of these patie nts, 580 consecutive episodes of chemotherapy-induced febrile neutrope nia in 253 children and adolescents with cancer between June 1992 and May 1995 were reviewed. Three hundred thirty episodes ended in dischar ge before the patient's ANC was >500/mm(3). Patients were characterize d as being at relatively lower risk if they had sterile blood cultures , were afebrile for >24 hours, appeared well, and were thought to have evidence of marrow recovery. Of the 330 episodes, only 21 (6%) were a ssociated with admission for recurrent fever during the subsequent 7 d ays. In retrospect, in only six of these 21 cases of readmission (or 2 % of 330 episodes) was there evidence of bone marrow recovery, and non e of the blood cultures were positive during the subsequent hospitaliz ation. All patients who met low-risk criteria fared well during their second hospitalization. This early discharge strategy was safe and res ulted in substantial cost savings.