Implementation of a Low-risk Algorithm for Outpatient Management of Febrile Pediatric Patients With Sickle Cell Disease

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 degrees 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.