MASCC Risk Index Score
Purpose
The MASCC (Multinational Association for Supportive Care in Cancer) Risk Index Score identifies adults with febrile neutropenia who are at low risk of serious complications to support consideration of ambulatory or oral management after initial assessment and stabilization (NICE CG151; NICE evidence review).
Clinical context and role in the ED
Febrile neutropenia can present atypically and is time‑critical. Initial care must prioritise rapid assessment and empirical antibiotics when neutropenic sepsis is suspected.
The MASCC score is an adjunct to, not a replacement for, immediate resuscitation and sepsis pathways - use it after physiological stabilisation and alongside clinical judgement, NEWS2/local sepsis escalation and local outpatient pathways (RCEM; NICE CG151).
Scoring components
Assign the points for each applicable item and sum for a total score. Only one burden-of-illness item (no/mild symptoms or moderate symptoms) should be used for a given patient.
Threshold and interpretation
- Total ≥ 21: classified as low risk of serious complications; may be considered for outpatient/ambulatory management (for example, early discharge with oral antibiotics) provided other safety criteria and local governance arrangements are met (NICE CG151; evidence review).
- Total < 21: higher risk - usually managed as inpatient with close monitoring and intravenous therapy.