{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:30:10Z","timestamp":1768350610975,"version":"3.49.0"},"reference-count":19,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,3,27]],"date-time":"2019-03-27T00:00:00Z","timestamp":1553644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fever and neutropenia is a common reason for nonelective hospitalization of pediatric oncology patients. Herein we report nearly five years of experience with a clinical pathway designed to guide outpatient management for patients who had low\u2010risk features.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedures<\/jats:title><jats:p>Through a multidisciplinary collaboration, we implemented a clinical pathway at our institution using established low\u2010risk criteria to guide outpatient management of pediatric oncology patients. Comprehensive chart review of all febrile neutropenia episodes was conducted to characterize outcomes of patients with low\u2010risk febrile neutropenia following clinical pathway implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between April 1, 2013, and October 1, 2017, there were 169 cases of febrile neutropenia managed in our Pediatric Oncology Unit. Sixty\u2010seven (40%) of these episodes were defined as low risk and managed either entirely in the outpatient setting (41 episodes, 24%) or with a step\u2010down strategy involving a very brief inpatient stay (26 episodes, 15%). There were no intensive care unit admissions or deaths among the low\u2010risk patients. Of those identified as low risk, seven patients (10%) required subsequent hospitalization during the follow\u2010up period, two for inadequate oral intake, two for persistent fevers, one for cellulitis, one for seizure unrelated to the febrile episode, and one for a positive blood culture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Following implementation of a clinical pathway, the majority of patients designated as low risk were managed primarily in the outpatient setting without major morbidity or mortality, suggesting that carefully selected low\u2010risk patients can be successfully treated with outpatient management and subsequent admission if warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.27679","type":"journal-article","created":{"date-parts":[[2019,3,28]],"date-time":"2019-03-28T01:04:14Z","timestamp":1553735054000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Outcomes of a clinical pathway for primary outpatient management of pediatric patients with low\u2010risk febrile neutropenia"],"prefix":"10.1002","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6891-8497","authenticated-orcid":false,"given":"Jonathan","family":"Paolino","sequence":"first","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital for Children  Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana","family":"Mariani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Boston Children's Hospital  Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital for Children  Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Rupon","sequence":"additional","affiliation":[{"name":"Global Product Development Pfizer Inc.  Collegeville PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital for Children  Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annah","family":"Abrams","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Massachusetts General Hospital for Children  Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Friedmann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Massachusetts General Hospital for Children  Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-015-1413-8"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.13.8222"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-199905000-00009"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.01.077"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2011.213"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.71.7017"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21219"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.50.4.385"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(79)90390-5"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(82)90594-0"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197105132841904"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/514512"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19940701)74:1<189::AID-CNCR2820740130>3.0.CO;2-7"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8588(18)30212-0"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)82536-3"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.42.7161"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.35.0884"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044097"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.12512"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.27679","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pbc.27679","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.27679","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T18:13:31Z","timestamp":1694369611000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.27679"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,27]]},"references-count":19,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1002\/pbc.27679"],"URL":"https:\/\/doi.org\/10.1002\/pbc.27679","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,27]]},"assertion":[{"value":"2018-06-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e27679"}}