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    MASCC Risk Index for Febrile Neutropenia

    Identifies patients at low risk for poor outcome with febrile neutropenia.
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    INSTRUCTIONS

    Use in neutropenic patients (see ANC calculator) with fever at least 100.4°F (38ºC). Do not use in patients with acute leukemia undergoing induction chemotherapy or allogeneic hematopoietic stem cell transplant conditioning, per IDSA guidelines.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Use at fever onset to assess risk of complications in febrile neutropenia for patients undergoing chemotherapy treatment.
    • Use after addressing immediate concerns to identify patients who may not need to be admitted to the hospital or could be discharged early.
    • Only applies to adult patients.
    • Validated as a dichotomous outcome; i.e., low risk versus not low risk. Obviously, patients who are “not low risk” have varying degrees of risk.

    Febrile neutropenia is a potentially life-threatening complication of chemotherapy, but some patients are at low risk for serious complications. The MASCC Risk Index is an internationally validated scoring system that identifies these low risk patients that can potentially be treated as an outpatient with early antibiotics.

    None or mild
    +5
    Moderate
    +3
    Severe
    0
    No
    +5
    Yes
    0
    No
    +4
    Yes
    0
    Solid tumor
    +4
    Hematologic, no prior fungal infection
    +4
    Hematologic, prior fungal infection
    0
    No
    +3
    Yes
    0
    Outpatient
    +3
    Inpatient
    0
    <60
    +2
    ≥60
    0

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Higher scores indicate lower risk, with a maximum of 26 points.  Using a cutoff value of >21 points discriminates patients with low risk from those with high risk (<21 points) for serious complications of febrile neutropenia, e.g. death, ICU admission, hypotension (see Formula for complete list).

    Management

    • The MASCC has been endorsed by the Infectious Disease Society of America (IDSA) since 2002 with Level B (moderate) evidence supporting its use. However, most experts consider high risk patients to be those with anticipated prolonged neutropenia (>7 days), profound neutropenia (ANC <100) and/or co-morbid conditions (in addition to COPD)—Level A evidence—that are not necessarily accounted for in the MASCC. Therefore, clinical judgment by specialists (infectious disease, hematology/oncology or emergency medicine/internal medicine/critical care) with knowledge of predicted disease-specific chemotherapy effects may override the MASCC Score.
    • High risk patients require admission for IV antibiotics.
    • Carefully-selected low risk patients should receive oral or IV empiric antibiotics in a clinic or hospital setting and may be transitioned to outpatient regimens if they meet certain criteria (see algorithm below).  

    *Adapted from the IDSA Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer, 2010.

    Critical Actions

    IDSA recommends admission for empiric antibiotics for high-risk patients not already admitted to the hospital.

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    About the Creator
    Dr. Jean Klastersky
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