Outcomes of febrile events in pediatric patients with sickle cell anemia

Sirigaddi, Krishnaveni; Aban, Inmaculada; Jantz, Amelia; Pernell, Brandi; Hilliard, Lee; Bhatia, Smita; Lebensburger, Jeffrey D.

doi:10.1002/pbc.27379

Cited by 12 publications

(6 citation statements)

References 30 publications

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“…The SoC WG members reviewed 15 guidelines from US, UK, France, Brazil and Jamaica and from the three sites in SPARCo and SADaCC. These guidelines were grouped into African ( Alli et al, 2014 ; MEDBOX, 2022 ) and non-African guidelines ( Sickle Cell Unit, 1997 ; Ali Susanna, 2008 ; Sicklecell Society, 2010 ; De Montalembert et al, 2011 ; NICE, 2012 ; CanHaem, 2014 ; Heart and Institute, 2014 ; Colombatti and Sainati, 2016 ; Sicklecell Society, 2018 ; Sirigaddi et al, 2018 ; Liem et al, 2019 ; Wilson, 2019 ). These guidelines were mostly national guidelines for the tertiary level healthcare ( Table 3 ).…”

Section: Methodsmentioning

confidence: 99%

Development of multi-level standards of care recommendations for sickle cell disease: Experience from SickleInAfrica

et al. 2023

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Introduction: Sickle Cell Disease (SCD) causes significant morbidity and mortality particularly in sub-Saharan Africa (SSA) where it contributes to early childhood deaths. There is need to standardize treatment guidelines to help improve overall SCD patient health outcomes. We set out to review existing guidelines on SCD and to set minimum standards for management of SCD for the different referral levels of healthcare.Methods: A standards of care working group (SoC-WG) was established to develop the SoC recommendations. About 15 available SCD management guidelines and protocols were reviewed and themes extracted from them. The first draft was on chosen themes with 64 major headings and subtopics. Using a summarised WHO levels of referral document, we were able to get six different referral levels of healthcare. The highest referral level was the tertiary facilities whilst the lowest level was the home setting. Recommendations for SCD management for the regional, district, sub-districts, health posts and CHPs compounds were also drafted.Results: The results from this review yielded a guidelines document which had recommendations for management of SCD on 64 topics and subtopic for all the six (6) different referral levels.Discussions: Every child with SCD need to receive comprehensive care that is coordinated at each level. This recommendation is unique in terms of the availability of recommendations for different levels of care as compared to the traditional guidelines which is more focused at the tertiary levels. Patients can access care at any of the other lower referral hospitals and be managed with recommendations that are in keeping with institutional resources at that level. When such patients need care that requires expertise that is not available at that level, the recommendations will be to refer to the appropriate referral level where those expertise are available. This encourages patients to have good clinical care nearer their homes but also having access to specialist screening modalities and expertise at the tertiary hospitals if need be. With this, patient are not limited to a specific referral level when interventions cannot be instituted for them.Conclusion: This SoC recommendations document is a useful material that can be used for consistent standards of treatment in SSA.

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Section: Methodsmentioning

confidence: 99%

Development of multi-level standards of care recommendations for sickle cell disease: Experience from SickleInAfrica

et al. 2023

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“…5 However, subsequent studies did not find an association between these criteria and bacteremia. 3,7 See Table 1 for the authors' institution's recommended criteria for discharge of pediatric patients >2 months old with SCD presenting to the ED with a temperature ≥38.3°C within the past 48 hours. 6 These criteria are supported by a more recent study of children with SCD presenting to an ED with fever, which found that ill appearance, hypotension, or white blood cell count >30 Â 10 9 /L was associated with bacteremia.…”

Section: Initial Managementmentioning

confidence: 99%

“…6 These criteria are supported by a more recent study of children with SCD presenting to an ED with fever, which found that ill appearance, hypotension, or white blood cell count >30 Â 10 9 /L was associated with bacteremia. 7 Although the 2014 guidelines recommend subsequent outpatient oral antibiotics for discharged children, studies have found that current automated blood culture detection systems will detect most bacterial pathogens within 24 hours, and thus, it is safe not to administer outpatient antibiotics in well-appearing children. 3,8…”

Section: Initial Managementmentioning

confidence: 99%

New Horizons in Emergency Department Management of Pediatric Sickle Cell Disease

Umana,

Lapite,

Ellison

2024

Pediatr Emer Care

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Sickle cell disease (SCD) is an important topic for emergency medicine audiences because complications of the disease account for a large proportion of hematologic emergencies that are seen in the emergency department each year. Early recognition and aggressive management of emergency complications of SCD can help to reduce the morbidity and mortality associated with this disease. Although the treatment recommendations for some complications of SCD are based on expert opinion, there has been advancement in the understanding of the pathogenesis of the disease and evidence regarding the treatment options available for managing acute complications. This continuing medical education article will provide a summary of the clinical manifestation and management of the most common acute complications of SCD: infection, vaso-occlusive episode, acute chest syndrome, splenic sequestration, stroke, and priapism.

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“…Mortality rates have remained extremely low using these principles. 7,8 Less is known about the costs of this strategy. For instance, the incidence and consequences of ceftriaxone-induced hemolytic anemia have not been widely measured.…”

Section: + Related Articlementioning

confidence: 99%

“…Often this includes an extensive clinical and laboratory evaluation (blood culture, complete blood and reticulocytes counts, chest radiograph for those with respiratory symptoms, and urinalysis and urine culture in children aged <3 years and with those with symptoms of urinary tract infection). Mortality rates have remained extremely low using these principles . Less is known about the costs of this strategy.…”

mentioning

confidence: 99%

Fever in Children With Sickle Cell Disease—Rethinking the Approach When Bacteremia Is Rare

Noronha

Strouse

2023

JAMA Netw Open

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Outcomes of febrile events in pediatric patients with sickle cell anemia

Abstract: Institutions can develop admission criteria based on WBC count, hypotension, and "ill appearance." Persistently febrile, well-appearing patient can be discharged at 48 h with minimal risk for new complications.

Cited by 12 publications

References 30 publications

Development of multi-level standards of care recommendations for sickle cell disease: Experience from SickleInAfrica

Development of multi-level standards of care recommendations for sickle cell disease: Experience from SickleInAfrica

New Horizons in Emergency Department Management of Pediatric Sickle Cell Disease

Fever in Children With Sickle Cell Disease—Rethinking the Approach When Bacteremia Is Rare

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