Therefore, results could have been biased because EDs that participated were possibly more involved in the management of patients with sepsis and/or cancer. However, these centres were geographically distributed across France and were representative selleck compound of French EDs because they were mostly set in general hospitals. In addition, only 19 Eds had a written procedure for febrile neutropenia. The convenience series was also limited because no patient waived the invitation to participate in this prospective study. Another limitation was the use of MASCC criteria to decide on the site of care and antimicrobial therapy because this score has never been validated in the ED setting. Stratification of patients using the MASCC scoring system is debatable as consensus meetings suggest that it is not superior to expert advice.

However, the MASCC classification has been regularly used as a gold standard to stratify patients with febrile neutropenia. In addition MASCC calculation depends on the burden of the onco-haematological disorder. However, it is usually accepted that patients with advanced cancer under-estimate the severity of the disorder [34,35]. As emergency physicians usually obtain past medical history from patients’ interviews, they may misclassify severity of febrile neutropenia when assessed by MASCC level. Finally, we found that patients with more severe and mild febrile neutropenia were inadequately treated according to a univariate analysis. We were unable to identify risk factors for inadequate management by a multivariate analysis, partly because of the size of the sample.

ConclusionsPatients with febrile neutropenia who visit the EDs are likely to develop severe infection. In this sample, patients who met our definition of SS/SSh had a low rate of being treated with adequate fluid and a low rate of evaluation with serum lactate level. Patients who were considered to be low risk were often admitted to the hospital rather than being discharged home on oral antibiotics. More work is needed within the standard operation protocols of EDs as well as outcome-based research to optimise care for these patients.Key messages? Patients with febrile neutropenia are likely to present to the ED with severe infections.? More severe patients are poorly recognised and under-treated.? Patients with mild disorders are over-treated.

? Patients with febrile neutropenia presenting to the ED are usually not treated according to guidelines.AbbreviationsED: emergency department; G-CSF: granulocyte-cell Dacomitinib stimulating factor; MASCC: Multinational Association of Supportive Care in Cancer; SS: severe sepsis; SSh: septic shock.Competing interestsYann-Erick Claessens received fees from Amgen France. All other authors declare that they have no competing interests.Authors’ contributionsSA contributed to the conception, design, and drafting of the manuscript. PT contributed to collection of the data.