The adequacy Z-VAD-FMK side effects of management according to recommendations was determined for the two sub-groups using Pearson’s chi-squared test or Fisher’s exact test for qualitative variables and the Student’s t test or Wilcoxon rank sum test for quantitative variables. All tests were two-sided. A P value of less than 5% were considered statistically significant. All statistical analyses were carried out using R software (Vienna University of Economics and Business, 1090 Vienna, Austria).ResultsEmergency departmentsThe 47 participating EDs were distributed across France and were representative of each metropolitan region. Thirteen (28%) centres were tertiary teaching hospitals, six (13%) were in the Paris area and 29 (60%) had a dedicated unit for cancer patients.

The median number of hospital beds was 500 (range, 150 to 2900) and the median number of ED visits was 17,679 during the six months of the study (range, 3,000-39,045). A written procedure for the management of febrile neutropenia was present in 19 EDs (40%) and was formalised with oncologists/haematologists in 15 (32%). This procedure referred to protective isolation in 10 (21%), antimicrobial agents in 16 (34%) and growth factors in 5 (11%) EDs.Study participants and febrile neutropeniaAmong the 777,876 patients who visited the EDs during the study period, 198 fulfilled the inclusion criteria (mean age 61 �� 14 years, 116 (60%) male) corresponding to one case every 3,930 visits; all these patients accepted to participate (Figure (Figure1).1). Thirteen centres included five patients or more (Tables (Tables22 and and33).

Figure 1Flow chart of patients included in the study.Table 2Characteristics of participating centresTable 3Details of location, activity, inclusions and dedicated unit for cancer patients in participating centresA solid neoplasm was reported in 111 patients (56%) and haematological cancer in 87 (44%). Seventy-four patients (39%) had an underlying disorder. Patients often self-referred to the ED (n = 87, 44%). Forty-seven (24%) patients were treated with G-CSF to prevent neutropenia and 174 (88%) had one or more risk factors that should have prompted the prophylactic use of G-CSF (Table (Table44).Table 4Prescription of G-CSFThe characteristics of the patients are summarised in Table Table5.5. Median delay between chemotherapy and ED visit was 10 days, ranging from 4 to 35 days.

According to the criteria selected for disease severity, 89 (45%) patients had SS/SSh, 108 (55%) Dacomitinib did not have SS/SSh and one could not be classified.Table 5Characteristics of the patientsAmong the 89 patients with SS/SSh, ED physicians recognised the severity signs in 45 (55%). Blood cultures were obtained from 87 (98%) patients and lactate concentration was measured in 29 (32%). Antimicrobial therapy with a broad-spectrum beta-lactam was started within 90 minutes in 19 of 86 (22%) patients (data missing for three). Among these patients, nine (10%) also received an aminoglycoside.