Welcome to the CISNE calculator website! The aim of this tool is to identify those patients with febrile neutropenia who are seemingly stable in the first hours and who throughout the evolution of their febrile process develop serious, unexpected complications and who, therefore, despite the initial lack of evident criteria of severity, are not truly stable. Some will have acute respiratory insufficiency, others will have shock, etc., and the first signs of alarm will not always be detectable at the first evaluation or triage in the Emergency Department.
This tool is intended only for seemingly stable patients, so we will check the eligibility criteria before you can access the calculator. The researchers of the FINITE Study defined the concept of clinical stability on the basis of the selection criteria of randomized clinical trials that compared oral versus intravenous treatment, or outpatient versus inpatient, because our prime objective was to improve the safety of these empirical selection criteria and make them even stricter and safer for the patient.
FINITE was an observational study in clinical practice and as such, specific recommendations cannot be made regarding the use of therapeutic G-CSF or specific antibiotic schedules in this population, which would have to be elucidated in clinical trials.
The scope of the model’s applicability must always be confirmed and attention must be paid to unusual risk factors that may be important in a minority of patients. The CISNE score should not be used to select low risk patients who are eligible for outpatient care with oral antibiotics, until a clinical trial can be carried out to confirm the safety of this approach.
Predictions are only orientative, so decisions should be taken at the discretion of the attending physician. However, CISNE could in fact be useful to delay or avoid early discharge of certain seemingly stable patients who begin inpatient treatment until they demonstrate to be truly stable and blood cultures are verified to be negative.