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Outcomes of febrile events in pediatric patients with sickle cell anemia

Krishnaveni Sirigaddi1, Inmaculada Aban2, Amelia Jantz1

  • 1Department of Pediatrics, Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, Alabama.

Pediatric Blood & Cancer
|August 3, 2018
PubMed

Insights

Febrile sickle cell patients can be safely discharged with specific criteria, reducing unnecessary hospital admissions. Key indicators like "ill appearance" and hypotension help identify patients needing admission for bacteremia risk.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Emergency Medicine

Background:

  • Limited guidelines exist for admitting febrile sickle cell patients.
  • Lack of data on readmission rates for these patients after ED or hospital discharge.

Purpose of the Study:

  • To analyze bacteremia outcomes in febrile sickle cell patients.
  • To determine readmission rates for febrile sickle cell patients discharged from the ED or hospital.

Main Methods:

  • 16-year retrospective study of febrile sickle cell patients.
  • Analyzed risk variables: fever, abnormal white blood cell (WBC) count, tachycardia, hypotension, and "ill appearing."
  • Assessed 14-day readmission rates for discharged patients.

Main Results:

  • Bacteremia occurred in 2.6% of febrile events.
  • "Ill-appearing" patients had an 8.5-fold increased odds of bacteremia.
  • Models with WBC count, "ill appearing," and hypotension showed high sensitivity and specificity (AUC > 0.75).
  • Only 2.3% of discharged patients were readmitted for new sickle cell complications.

Conclusions:

  • Institutions can use WBC count, hypotension, and "ill appearance" for admission criteria.
  • Persistently febrile, well-appearing patients can be discharged at 48 hours with low readmission risk.
Abstract

Keywords:
bacteremiafeverinfectionoutcomessickle cell anemia

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