Emergency department evaluation of early warning scores in predicting mortality in febrile neutropenia patients

Physiology-based early warning scores, particularly NEWS and MEWS, outperformed oncology-specific indices for early mortality prediction in FN patients in the ED. Incorporating these rapid scores alongside MASCC or CISNE could enhance triage accuracy, inform disposition and ultimately improve outcomes. Key messages What is already known on this topic? Febrile neutropenia (FN) is a life-threatening oncologic emergency requiring rapid risk stratification in the emergency department. Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) are commonly used oncology-specific tools for risk assessment, but their performance in acute emergency department (ED) settings is variable. General early warning scores like National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), and Quick Sequential Organ Failure Assessment (qSOFA) have been validated for sepsis but less frequently applied to febrile neutropenic patients. What this study adds? This study is among the few to directly compare MASCC, CISNE, NEWS, MEWS, and qSOFA in predicting in-hospital mortality in FN patients in the ED. NEWS and MEWS demonstrated the highest area under the curve values and more balanced sensitivity-specificity ratios, outperforming oncology-specific scores. Vital sign-based scores, calculated rapidly at presentation, offer strong prognostic value for early identification of high-risk FN patients. How this study might affect research, practice, or policy? Supports the integration of physiologic early warning scores (NEWS and MEWS) into FN triage protocols in emergency departments. Suggests a multidimensional risk assessment model combining both oncologic and general scoring systems for more accurate and efficient patient management. May influence policy and guideline development to enhance outpatient vs. inpatient decision-making and resource allocation in FN care.