Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Sickle Cell Disease with Fever

All children with sickle cell disease and a central venous catheter/apheresis port should be treated according to the Non-oncology with CVC and Fever Pathway.
Review criteria for:
ED RN Standing Order for SCD, fever
Clinically Suspected
Acute Chest Syndrome
2-11 mos or
≥ 12 mos and All Low-risk Criteria Not Met
12 mos-16 yrs
Meets All Low-risk Criteria
≥ 17 yrs
Meets All Low-risk Criteria
Ampicillin
Azithromycin
Send Type and Cross
Ampicillin
Ceftriaxone
Observe 2 hrs
Levofloxacin
Admit
Discharge
  • Review with Hematology Consultant
  • If all Low-risk Criteria are not met, admission is required
  • If all Low-risk Criteria are met, eligible for discharge after Hematology consultation
Low-risk Criteria
Clinical Labs, X-ray Findings PMH, Social History
  • ≥ 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
  • No central venous catheter
  • Hgb > 5g/dL
  • Reticulocyte count > 1%
    • (Unless Hgb > 10g/dL)
  • No significant drop Hgb (> 2g/dL)
  • WBC > 5 K and < 30 K
  • Chest X-ray (if indicated) without infiltrate
  • UA (if indicated) normal
  • No history of:
    • Bacteremia
    • Sepsis
    • History of splenic sequestration in past 4 wks
    • Recent antibiotic treatment
    • Multiple visits for same febrile illness
  • 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: July 2022
Authors: A. Ellison, MD; C. Witmer, MD; J. Lavelle, MD; C. Jacobstein, MD; C. Norris, MD; R. Cecil, RN, MSN; T. McKnight, CRNP; K. Smith Whitley, MD