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 patients) 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 patients, 580 consecutive episodes of chemotherapy-induced febrile neutropenia in 253 children and adolescents with cancer between June 1992 and May 1995 were reviewed. Three hundred thirty episodes ended in discharge before the patient's ANC was >500/mm(3). Patients were characterized 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 associated with admission for recurrent fever during the subsequent 7 days. In retrospect, in only six of these 21 cases of readmission (or 2% of 330 episodes) was there evidence of bone marrow recovery, and none of the blood cultures were positive during the subsequent hospitalization. All patients who met low-risk criteria fared well during their second hospitalization. This early discharge strategy was safe and resulted in substantial cost savings.