• Am J Emerg Med · May 2023

    Observational Study

    Clinical factors predicting return emergency department visits in chemotherapy-induced febrile neutropenia patients.

    • Sejin Heo, Kyeongman Jeon, Boram Park, Ryoung-Eun Ko, Taerim Kim, Sung Yeon Hwang, Hee Yoon, Tae Gun Shin, Won Chul Cha, and Se Uk Lee.
    • Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06355 Seoul, Republic of Korea; Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 06355 Seoul, Republic of Korea.
    • Am J Emerg Med. 2023 May 1; 67: 909690-96.

    BackgroundAlthough chemotherapy-induced febrile neutropenia (FN) is the most common and life-threatening oncologic emergency, the characteristics and outcomes associated with return visits to the emergency department (ED) in these patients are uncertain. Hence, we aimed to investigate the predictive factors and clinical outcomes of chemotherapy-induced FN patients returning to the ED.MethodThis single-center, retrospective observational study spanning 14 years included chemotherapy-induced FN patients who visited the ED and were discharged. The primary outcome was a return visit to the ED within five days. We conducted logistic regression analyses to evaluate the factors influencing ED return visit.ResultsThis study included 1318 FN patients, 154 (12.1%) of whom revisited the ED within five days. Patients (53.3%) revisited the ED owing to persistent fever (56.5%), with no intensive care unit admission and only one mortality case who was discharged hopelessly. Multivariable analysis revealed that shock index >0.9 (odds ratio [OR]: 1.45, 95% confidence interval [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) were associated with an increased risk of a return visit to the ED, whereas being transferred into the ED from other hospitals (OR: 0.08; 95% CI, 0.005-0.38) was associated with a decreased risk of a return visit to the ED.ConclusionHigh shock index, lactic acid, thrombocytopenia, and ED arrival type can predict return visits to the ED in chemotherapy-induced FN patients.Copyright © 2023 Elsevier Inc. All rights reserved.

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