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Sickle cell screening practice in pediatric emergency departments
1Medical College of Wisconsin, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee 53226.
Insights
Sickle cell screening is crucial for black children in emergency departments. Many children lack documented sickle cell status, necessitating in-ED screening for accurate management and diagnosis.
Area of Science:
- Pediatric Emergency Medicine
- Hematology
- Genetics
Background:
- Management of black children in pediatric emergency departments (EDs) often requires knowledge of their sickle cell status.
- Sickle cell disease is a significant health concern in pediatric populations.
Purpose of the Study:
- To determine the current practices of sickle cell screening in pediatric EDs.
- To evaluate the accessibility and utilization of newborn sickle cell screening results.
- To assess the need for in-ED sickle cell screening.
Main Methods:
- Survey of 32 pediatric EDs regarding sickle cell screening practices.
- Prospective review of 60 black children under two years old presenting to a pediatric ED.
- Analysis of patient records and physician communication regarding sickle cell status.
Main Results:
- 22 out of 28 surveyed EDs (79%) included sickle cell screening.
- Parents of only 18% of patients needing sickle cell status information knew their child's status.
- In-ED screening was required for 59% of patients, detecting three new cases of sickle cell trait.
Conclusions:
- Sickle cell screening is recommended for young black children presenting to EDs with fever or symptoms suggestive of sickle cell disease complications.
- Improved systems are needed for accessing and utilizing newborn screening results.
- In-ED screening plays a vital role in identifying sickle cell status when other methods fail.
Abstract:
Management of black children who present to a pediatric emergency department (ED) commonly requires knowledge of their sickle cell status. To determine the practice of sickle cell screening, 32 pediatric EDs were surveyed. Twenty-eight (88%) completed the survey, and, of these, 22 (79%) included sickle cell screening (differential solubility test for hemoglobin S) in the management of a black febrile six-month-old infant. To determine the method of screening for sickle cell disease, 60 consecutive black children less than two years of age, who presented to a pediatric ED, were reviewed prospectively. In 51 patients (85%), their condition warranted knowledge of their sickle cell status. Of these, parents of only nine (18%) children knew their child's sickle cell status. Thirty-five (69%) patients had a presumptive newborn screening test for sickle cell disease, but only 15 presented between 8 AM and 5 PM on a weekday, the time during which the newborn screening laboratory could be telephoned for test results. For these same 15 patients, 13 had private physicians, but only three physicians had results of newborn sickle cell screening tests. The patients' hospital records were reviewed, and nine (18%) patients had prior sickle cell screening tests, but five of these tests were performed before the child was six months of age. To determine sickle cell status, 30 (59%) patients required a sickle cell screening test in the ED. ED screening detected three (6%) newly diagnosed sickle cell trait patients. In summary, sickle cell screening is recommended for young black children who present to an ED with fever or signs and symptoms supportive of sickle cell disease complications.(ABSTRACT TRUNCATED AT 250 WORDS)