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Clinical Criteria

Select All That Apply

Outpatient at presentation

History of sepsis within previous 6 months

Down Syndrome

HSCT patient within 6 months of transplant and/or receiving immunosuppressants

AML

Burkitt lymphoma/leukemia or Intensive B lymphoma protocol

ALL not in maintenance

High Risk Neuroblastoma

Relapsed leukemia or progressive/relapsed malignancy with suspected
or proven bone marrow involvement

Sepsis Syndrome

Hypotension

Tachypnea

Hypoxia (O2 saturation < 94% on room air)

New infiltrates on chest X-ray

Altered mental status

Mucositis ≥ grade 3

Grade 1: Asymptomatic or mild symptoms; intervention not indicated
Grade 2: Moderate pain; not interfering with oral intake; modified diet indicated
Grade 3: Severe pain; interfering with oral intake
Grade 4: Life-threatening consequences; urgent intervention indicated
Grade 5: Death

Vomiting ≥ grade 3

Grade 1: 1-2 episodes (separated by 5 minutes) in 24 hrs
Grade 2: 3-5 episodes (separated by 5 minutes) in 24 hrs
Grade 3: ≥ 6 episodes (separated by 5 minutes) in 24 hrs; tube feeding, TPN or hospitalization indicated
Grade 4 - Life threatening consequences; urgent intervention indicated
Grade 5 - Death

Abdominal pain ≥ grade 3

Grade 1: Mild pain
Grade 2: Moderate pain; limiting instrumental ADL
Grade 3: Severe pain; limiting self care ADL
Grade 4: NA
Grade 5: NA

Clinical typhilitis

Evidence of significant local infection (e.g. tunnel infection, peri-rectal abscess, cellulitis

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