The Multinational Association for Supportive Care in cancer criteria. An Evaluation and recommendations for the management of neutropenia in the emergency department

Abstract

Objectives

We aimed to evaluate the reproducibility, accuracy, feasibility, and effect of the Multinational Association for Supportive Care in Cancer (MASCC) criteria on emergency clinical decisions, treatment, and health outcomes.

Methods

A retrospective cohort design was used.

Results

The MASCC score was better at correctly detecting the high urgency (70 % of patients with a high urgency were identified as high risk) than the low urgency (only 30 % of patients with a low urgency were identified as low risk). The examination of the MASCC score as a continuous variable could have been more valuable and indicated inferior validity. The likelihood ratios were far from good, which is better for ruling out the high urgency. The observed likelihood ratio of the MASCC range 17 to 20 provided no information for the goodness of the scale (equal to one). The results from multiple linear regression analyses identified that the MASCC original categorization (high vs. low risk) and the investigated new one (multiple ranges of MASCC score) were significantly associated with time to reassessment, time to be seen, time to decide on admission, boarding time until disposition, and length of stay. However, the original categorization nor the new one was predictive of the admission site. Still, both were significantly associated with hospital disposition (mortality) (p < 0.05).

Conclusion

Even though the MASCC score determines the neutropenia treatment pathway, the sensitivity and specificity analysis identified that the scale did not perform well in detecting real clinical urgency.