Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department  Christopher J. Coyne, MD, Vivian Le, BS, Jesse J. Brennan, MA, Edward M. Castillo, PhD, MPH, Rebecca A. Shatsky, MD, Karen Ferran, PhD, Stephanie Brodine, MD, Gary M. Vilke, MD  Annals of Emergency Medicine  Volume 69, Issue 6, Pages 755-764 (June 2017) DOI: 10.1016/j.annemergmed.2016.11.007 Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 1 Plot of patient enrollment and risk stratification using CISNE and MASCC scoring. ECOG PS, Eastern Cooperative Oncology Group performance score; SBP, systolic blood pressure; SIH, stress-induced hyperglycemia; COPD, chronic obstructive pulmonary disease; CVD, chronic cardiovascular disease. *Stress-induced hyperglycemia: initial blood glucose level ≥121 mg/dL or ≥250 mg/dL if patient has history of diabetes mellitus or if patient is receiving steroids. †COPD with the use of steroids, supplemental oxygen, or bronchodilators. ‡Excluding single uncomplicated episode of atrial fibrillation in the past. §At least the presence of patchy ulcerations or pseudomembranes, or moderate pain with modified diet indicated. ‖Patients who had evidence of acute organ failure, severe infection, hypotension, or another reason for admission were automatically considered high risk. Annals of Emergency Medicine 2017 69, 755-764DOI: (10.1016/j.annemergmed.2016.11.007) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 2 Variations in test characteristics for the MASCC score in the identification of a high-risk cohort as the low-risk cutoff is modified. Annals of Emergency Medicine 2017 69, 755-764DOI: (10.1016/j.annemergmed.2016.11.007) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 3 Distribution of negative outcome variables based on CISNE and MASCC scores. Upgrade: any upgrade in level of care while admitted. Deterioration: acute organ failure (laboratory or clinical evidence of acute renal failure, liver failure, heart failure, or respiratory failure), altered mental status, hypotension, or other disease process that necessitated an acute change in clinical management. Bacteremia: at least one positive blood culture. Annals of Emergency Medicine 2017 69, 755-764DOI: (10.1016/j.annemergmed.2016.11.007) Copyright © 2016 American College of Emergency Physicians Terms and Conditions

Figure 4 Patients with at least one negative outcome among CISNE and MASCC risk groups, stratified by ANC and tumor type. Liquid cancer includes all lymphoma and leukemia. Solid cancer includes all solid tumors such as lung, breast, pancreatic, colon, rectal, uterine, and ovarian. Annals of Emergency Medicine 2017 69, 755-764DOI: (10.1016/j.annemergmed.2016.11.007) Copyright © 2016 American College of Emergency Physicians Terms and Conditions