ED Pathway for Evaluation/Treatment of Children with
Sickle Cell Disease with Fever
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Ill Appearing
2 mos-12 mos or
>12 mos with recent
ceftriaxone (<8 wks)
Clinically Suspected
Acute Chest Syndrome
>12 mos
No recent ceftriaxone
(> 8 weeks)
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Vancomycin
+ ceftriaxone
Ampicillin
Admit HACU
Ampicillin
Azithromycin
Admit
Ceftriaxone
Observe 2 hrs
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Discharge
If all Low Risk Criteria met,
patients are eligible for ceftriaxone and discharge after Hematology consultation
CLINICAL
  • >12 mos
  • Well-appearing
  • Good VS
  • Tolerating po well
  • No concern for complications
    • Sequestration
    • Acute chest syndrome
    • VOC requiring IV analgesia
  • No new hypoxia
  • O2 sat ≥ 92% if baseline not known or
  • RA sat < 3% below baseline
LABS/X-RAY FINDINGS
  • Hgb >5
  • Reticulocyte count >1%
    (unless Hgb >10)
  • No significant drop Hgb (>2g)
  • WBC >5K and < 30K
  • Chest x-ray (if indicated) without infiltrate
  • UA (if indicated)
SCD PMH/SOCIAL

No history of:
  • Ceftriaxone in preceding 8 weeks
  • Bacteremia
  • Sepsis
  • History of splenic sequestration within the past 4 weeks
  • Recent antibiotic treatment
  • Multiple visits for same febrile illness
  • The presence of splenectomy alone does not exclude a patient from discharge if all other low risk criteria are met.

No history of:
  • Non-compliance with penicillin prophylaxis
  • Missing, delayed immunizations
  • Low likelihood of follow-up:
    • No phone
    • No transportation
    • Currently in shelter
    • Missed appointments
Posted: January 2010
Revised: October 2011, January 2014
Authors: A. Ellison, MD; J. Lavelle, MD; C. Jacobstein, MD; C. Norris, MD; R. Cecil, RN, MSN;
T. McKnight, CRNP, E. Coyne, CRNP; H. Hartung, MD, K. Smith Whitley, MD