Sickle Cell Disease with Fever Clinical Pathway — Emergency and Outpatient Specialty Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Quality Story
Managing Children with Sickle Cell Disease and Fever at Home

All sickle cell patients with a central venous catheter/ apheresis port should be treated according to the
Non-Oncology Patient with a CVC and Fever Pathway

Sickle Cell Disease Patient with Fever

Rationale for Treating
and Discharging Low Risk
SCD Patients

Triage Criteria
HACU Direct Admit 8A-9P

MD/CRNP/RN Rapid Assessment
History & Physical
Additional Diagnostic Tests

Antibiotics, Treatment and Disposition

Ill Appearing

2 mos-12 mos or
12 mos-16 years
With recent Ceftriaxone
(< 8 weeks)

Clinically Suspected
Acute Chest Syndrome

12 mos-16 years
No Recent Cefriaxone
(> 8 weeks)

17 Years
and Older

Vancomycin and
Ceftriaxone

Ampicillin
Admit HACU

Ampicillin
Azithromycin
Admit

Ceftriaxone
Observe 2 hrs

Levofloxacin
Discharge

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
No Central Venous Access Device

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, May 2015, October 2015, September 2017, December 2017 (reviewed)
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

Learn More

Sickle Cell Disease with Fever Discharge Checklist

Evidence-Based Management of Sickle Cell Disease, Expert Panel Report, 2014

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.