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Implementation of a Low-risk Algorithm for Outpatient Management of Febrile Pediatric Patients With Sickle Cell
Jason Erno1, Laurence Noisette2, Shayla Bergmann2
1College of Medicine.
Insights
A new algorithm for managing fever in pediatric sickle cell disease (SCD) patients reduced hospital admissions by over 10%. This approach aims to decrease healthcare burdens for families and the system.
Area of Science:
- Pediatric Hematology
- Emergency Medicine
- Public Health
Background:
- Children with sickle cell disease (SCD) face increased risk of serious bacterial infections due to splenic dysfunction.
- Fever management in pediatric SCD patients often leads to recurrent hospital admissions, straining healthcare resources and impacting quality of life.
- Outpatient management of uncomplicated bacterial infections in SCD patients has shown reduced incidence without increased morbidity or mortality.
Purpose of the Study:
- To establish a collaborative algorithm between pediatric hematology/oncology and emergency medicine divisions.
- To identify low-risk pediatric SCD patients eligible for outpatient management of fever.
- To standardize the treatment pathway for febrile pediatric patients with SCD.
Main Methods:
- Retrospective review of pediatric SCD patients (under 18) presenting with fever (≥101°F) to the Pediatric Emergency Department.
- Data collected from July 1, 2018, to June 30, 2020, at the Medical University of South Carolina.
- Comparison of admission rates and 72-hour ED revisits pre- and post-algorithm implementation.
Main Results:
- Post-algorithm implementation, admission rates decreased from 55.2% to 43.6%.
- The rate of ED revisits within 72 hours slightly decreased from 6.7% to 5.9%.
- No patient deaths were recorded during the study period.
Conclusions:
- The developed pathway standardizes fever management in pediatric SCD patients.
- While not statistically significant, the observed >10% decrease in admissions suggests a meaningful reduction in healthcare burdens.
- The algorithm shows promise in optimizing care and reducing resource utilization for febrile pediatric SCD patients.
Background:
Splenic dysfunction in children with sickle cell disease (SCD) increases the risk of serious bacterial infections; therefore, families are instructed to seek medical care in the presence of fever. Recurrent hospital admissions of patients with SCD cause financial and resource burdens on caregivers and the health care system, contributing to a lower quality of life in this patient population. Recent studies have documented a reduction of the incidence of bacterial infections among these patients managed on an outpatient basis with no association of increased morbidity and mortality. We decided to establish a partnership between our pediatric hematology/oncology division and pediatric emergency medicine division to initiate an algorithm to identify low-risk patients eligible for outpatient management.
Procedure:
We conducted a retrospective review of patients with SCD younger than 18 years of age, followed at the Comprehensive Care Sickle Cell Center at the Medical University of South Carolina (MUSC), who presented to our Pediatric Emergency Department (ED) with a temperature ≥101°F from July 1, 2018 to June 30, 2020.
Results:
The mean length of stay and age at admission were nearly equal between pre-implementation and post-implementation of the algorithm. The admission rates from the study for were 55.2% and 43.6% pre-implementation and post-implementation, respectively. Patients revisited the ED within 72 hours in 6.7% of patients in pre-implementation and 5.9% of patients in post-implementation. There were no patient deaths.
Conclusions:
Our pathway helps standardize the treatment of febrile pediatric patients with SCD. Although the decrease in admissions did not reach statistical significance, the > 10% decrease in admissions was likely meaningful to reduce health care burdens for patients and families.
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