Outcomes of febrile events in pediatric patients with sickle cell anemia

BackgroundLimited evidence exists to create institutional admission criteria guidelines for febrile sickle cell patients. In addition, evidence is lacking to understand readmission rates for febrile sickle cell patients discharged from the emergency department (ED) or hospital. ProceduresWe conducted a 16-year retrospective study of bacteremia outcomes for febrile sickle cell patients. Risk variables analyzed included fever (either39.5 degrees C or 40 degrees C), abnormal white blood cell (WBC) (>30,000 or<5,000/mcL), tachycardia and hypotension, or ill appearing. Fourteen-day readmission rates were analyzed to determine outcomes for febrile sickle cell patients discharged from the ED or discharged within 72h. ResultsBacteremia was identified in 17 (2.6%) of 653 febrile events that are presented to the ED. Ill-appearing patients had an 8.5-fold increased odds of being diagnosed with bacteremia. Models using WBC count, ill appearing, and hypotension have the highest sensitivity and specificity (AUC>0.75). Among 427 patients discharged from the ED or within 72h of hospitalization, only 10 (2.3%) were readmitted for a new sickle cell complication. ConclusionsInstitutions can develop admission criteria based on WBC count, hypotension, and ill appearance. Persistently febrile, well-appearing patient can be discharged at 48h with minimal risk for new complications.