The following is a summary of “Clinical factors predicting return emergency department visits in chemotherapy-induced febrile neutropenia patients,” published in the May 2023 issue of Emergency Medicine by Heo, et al.
Chemotherapy-induced febrile neutropenia (FN) is a common and life-threatening oncologic emergency, but the characteristics and outcomes of patients returning to the emergency department (ED) are poorly understood. For a study, researchers sought to investigate the predictive factors and clinical outcomes of patients with chemotherapy-induced FN who returned to the ED.
The retrospective observational study spanned 14 years and focused on chemotherapy-induced FN patients who visited the ED and were subsequently discharged. The primary outcome measured was a return visit to the ED within five days. In addition, logistic regression analyses were performed to assess the factors influencing the likelihood of an ED return visit.
1,318 FN patients were included in the study, and 154 (12.1%) of them revisited the ED within five days. The most common reason for returning to the ED was persistent fever (56.5%), and there was only one mortality case among the revisiting patients (53.3%) who had been discharged without hope for improvement. Multivariable analysis identified several factors associated with an increased risk of a return visit to the ED, including shock index >0.9 (odds ratio [OR]: 1.45, 95% CI [CI], 1.01–2.10), thrombocytopenia (<100 × 103/uL) (OR: 1.64, 95% CI, 1.11–2.42), and lactic acid level > 2 mmol/L (OR: 1.51, 95% CI, 0.99–2.25). On the other hand, being transferred to the ED from other hospitals was associated with a decreased risk of a return visit to the ED (OR: 0.08; 95% CI, 0.005–0.38).
High shock index, elevated lactic acid levels, thrombocytopenia, and the method of arrival at the ED can be used to predict the likelihood of return visits to the ED in patients with chemotherapy-induced FN.