Sickle Cell Disease with Fever Clinical Pathway – Emergency Department

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

Goals and Metrics
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.
Child with Sickle Cell Disease and Fever
 
 

ED Triage

Review criteria for:
ED RN Standing Order for SCD, fever

 
 
 
 
 
 

ED Team Assessment

 
 
 
 
 
 
 
 
Clinically Suspected
Acute Chest Syndrome
2 mos – < 12 mos
or
≥ 12 mos and All Low-Risk Criteria Not Met
≥ 12 mos
All Low-Risk Criteria Met
 
 
 
 
 
 
Ampicillin
Azithromycin
Send Type and Cross
Ampicillin
Ceftriaxone
Observe 2 hrs for signs of hemolysis
 
 
 
 
 
 
Admit to Hematology
Discharge
Ensure all Low-Risk Criteria met with Hematology consult
Low-Risk Criteria
Clinical Labs, X-ray Findings PMH, Social History
  • ≥ 12 mos
  • Well-appearing
  • Good VS
  • Tolerating PO well
  • No concern for complications
    • Splenic sequestration
    • Acute chest syndrome
    • VOC requiring IV analgesia
  • No new hypoxia
    • SpO2 ≥ 92% if baseline not known
    • or
    • SpO2 < 3% below baseline
  • No central venous catheter
  • Hgb > 5 g/dL
  • Reticulocyte count > 1%
    • (Unless Hgb > 10 g/dL)
  • No significant drop Hgb (> 2 g/dL)
  • WBC > 5 K and < 30 K
  • Chest X-ray (if indicated) without infiltrate
  • UA (if indicated) without evidence of infection
  • No history of:
    • Bacteremia
    • Sepsis
    • Splenic sequestration in past 4 wks
    • Recent antibiotic treatment
    • Multiple visits for same febrile illness
  • Concern for:
    • Non-adherence with penicillin prophylaxis
    • Missing, delayed immunizations
    • Barriers for return/follow-up
      • Phone or transportation, residing in shelter
    • Inability to verify SCD History