Selected Topics: Oncological Emergencies EMERGENCY AMBULATORY MANAGEMENT OF LOW-RISK FEBRILE NEUTROPENIA: MULTINATIONAL ASSOCIATION FOR SUPPORTIVE CARE IN CANCER FITS-–REAL-WORLD EXPERIENCE FROM A UK CANCER CENTER William Marshall, MBCHB, Gerry Campbell, RGN, MSC, Thomas Knight, MBCHB, MRCP(UK), Tamer Al-Sayed, MBCHB, FRCP, and Tim Cooksley, MBCHB, FRCPE Department of Acute Medicine and Critical Care, The Christie, Manchester, United Kingdom Corresponding Address: Tim Cooksley, MBCHB, FRCPE, Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester M204BX, United Kingdom , Abstract—Background: Emergency patient presenta- tions with febrile neutropenia are a heterogeneous group. A small minority of these patients proceed to develop signif- icant medical complications. Risk stratification using scores, such as the Multinational Association for Supportive Care in Cancer score, have been advocated to identify patients who are at low risk of adverse outcome suitable for treatment on an ambulatory care pathway. Objectives: We sought to report the experience of 100 patients presenting acutely with neutropenic fever managed in an emergency ambula- tory fashion. Methods: Patients presenting as an emergency with low-risk febrile neutropenia managed in an ambula- tory setting between January 2017 and February 2019 at a tertiary cancer hospital in England were prospectively stud- ied. Patients with a fever >38.0  C and an absolute neutrophil count <1.0  10 9 /L were included. All patients with a Multi- national Association for Supportive Care in Cancer score $21 and a National Early Warning Score #3 were poten- tially eligible for the pathway. Complications were classified as serious if the patient developed persistent hypotension, respiratory failure, intensive care unit admission, altered mental status, disseminated intravascular coagulation, renal failure requiring renal replacement therapy, electrocardio- gram changes requiring antidysrhythmic treatment, and 30-day mortality. Results: One hundred patients with low- risk febrile neutropenia consecutively managed in an emer- gency ambulatory fashion were prospectively analyzed. Eighty-one patients were female and the median age was 51 y (range 17–79 y). No patients developed serious compli- cations. Eight (8% [95% confidence interval 4.1–15.0%]) patients had a 7-day readmission. Conclusion: Outpatient ambulatory care for emergency patients with low-risk febrile neutropenia can be delivered in a safe and effective fashion. Collaboration between acute care physicians and oncologists is required to develop local models based on na- tional guidelines to facilitate individualised care for emer- gency oncology patients. Ó 2019 Elsevier Inc. All rights reserved. , Keywords—ambulatory emergency care; early discharge; febrile neutropenia; MASCC INTRODUCTION Suspected neutropenic sepsis is an acute medical emer- gency, and empirical antibiotic therapy should be admin- istered immediately (1–3). However, neutropenic sepsis forms only a small subpopulation within the heterogenous emergency patient presentations of febrile neutropenia (4–6). Rigorously developed risk assessment tools, such as the Multinational Association for Supportive Care in Cancer (MASCC) and the Clinical Index of Stable Febrile Neutropenia (CISNE) exist for febrile neutrope- nia (7,8). Outpatient management guided by these scores Reprints are not available from the authors. RECEIVED: 20 March 2019; FINAL SUBMISSION RECEIVED: 21 September 2019; ACCEPTED: 21 September 2019 1 The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–5, 2019 Ó 2019 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter https://doi.org/10.1016/j.jemermed.2019.09.032