Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Sickle Cell Disease with Fever
- Related Pathways
- Sickle Cell Disease with Pain
- Fever
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
Non-Oncology Patient with a CVC and Fever Pathway
Ill Appearing
2 mos-12 mos or
12 mos-16 years
With recent Ceftriaxone
(< 8 weeks)
12 mos-16 years
With recent Ceftriaxone
(< 8 weeks)
Clinically Suspected
Acute Chest Syndrome
Acute Chest Syndrome
12 mos-16 years
No Recent Cefriaxone
(> 8 weeks)
No Recent Cefriaxone
(> 8 weeks)
17 Years
and Older
and Older
Vancomycin and
Ceftriaxone
Ceftriaxone
Admit
Ampicillin
Admit HACU
Ampicillin
Azithromycin
Azithromycin
Admit
Ceftriaxone
Observe 2 hrs
Observe 2 hrs
Levofloxacin
Discharge
Discharge
If all Low Risk Criteria met,
patients are eligible for ceftriaxone and discharge after Hematology consultation
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:
No history of:
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), March 2020
Authors: A. Ellison, MD; J. Lavelle, MD; C. Jacobstein, MD; C. Norris, MD; R. Cecil, RN, MSN; T. McKnight, CRNP; H. Hartung, MD; K. Smith Whitley, MD
Revised: October 2011, January 2014, May 2015, October 2015, September 2017, December 2017 (reviewed), March 2020
Authors: A. Ellison, MD; J. Lavelle, MD; C. Jacobstein, MD; C. Norris, MD; R. Cecil, RN, MSN; T. McKnight, CRNP; H. Hartung, MD; K. Smith Whitley, MD