Inpatient Clinical Pathway for Sickle Cell and Acute Chest Syndrome
Team Assessment
Diagnostic Criteria for ACS
- New infiltrate on CXR involving at least 1 lung segment that is not consistent with atelectasis and
- ≥ 1 of the following:
- Chest pain
- T ≥ 38.5°C
- Respiratory symptoms
- Cough, tachypnea, WOB
- Wheeze, rales
- Hypoxemia relative to baseline
ACS Criteria Not Met
Concern for ACS
Symptoms and no infiltrate
Symptoms and no infiltrate
ACS Criteria Met
Symptoms and new infiltrate
Symptoms and new infiltrate
- Further diagnostic work-up as clinically indicated
- Treat pain, fever
- Sickle Cell with Fever
- Sickle Cell with Pain
- Closely monitor symptoms
- Consider escalation of therapy to prevent progression
Discharge
- Review sickle cell disease discharge education
- Incentive spirometry instructions
- Recommended Follow-Up
Evidence
- Benefit of Pulmonary Subspecialty Care for Children with Sickle Cell Disease and Asthma
- Management of Sickle Cell Disease: Summary of the 2014 Evidence-Based Report by Expert Panel Members
- Pulmonary Complications of Sickle Cell Disease
- Lung Function in Sickle Cell Disease
- The Use of Incentive Spirometry in Pediatric Patients with Sickle Cell Disease to Reduce the Incidence of Acute Chest Syndrome
- Causes and Outcomes of the Acute Chest Syndrome in Sickle Cell Disease
- Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014.
- Positive Expiratory Pressure Device Acceptance by Hospitalized Children with Sickle Cell Disease is Comparable to Incentive spirometry
CHOP Programs
Podcast