Sickle Cell Disease with Fever Clinical Pathway – Emergency Department

History and Physical

SCD causes functional asplenia and immunocompromise which increases risk of life-threatening infections with encapsulated organisms and gram-negative bacteria
- E.g., S. pneumonia, H. influenzae, Salmonella, E. coli
Pneumococcal, HIB vaccination and PCN prophylaxis have reduced but have not eliminated bacteremia and sepsis
Most children < 5 yrs of age receive PCN prophylaxis
Infants < 1 yr have the highest risk of bacteremia
To assess health maintenance, current treatment and complications:
- Review most recent Hematology Letter

History	Duration of fever Presence of other symptoms, including pain Hydration Exposures Baseline hemoglobin and pulse oximetry reading Previous admissions, ICU admission Complications of sickle cell disease: Acute chest syndrome (ACS) Aplastic crisis (Parvovirus Infection) Stroke, TIA Splenic sequestration True bacteremia/sepsis Gall bladder disease Osteomyelitis, septic arthritis Transfusion history Surgical history, splenectomy Vaccination history, including Prevnar status Medications: Penicillin prophylaxis Hydroxyurea Folic acid Pain medications Others Allergies
Physical	General appearance, VS, pulse oximetry reading Presence of CVC Jaundice Respiratory status Circulatory status Neurologic status Evidence of focal infection Spleen size Presence of rash or petechiae

History

Duration of fever
Presence of other symptoms, including pain
Hydration
Exposures
Baseline hemoglobin and pulse oximetry reading
Previous admissions, ICU admission
Complications of sickle cell disease:
- Acute chest syndrome (ACS)
- Aplastic crisis (Parvovirus Infection)
- Stroke, TIA
- Splenic sequestration
- True bacteremia/sepsis
Gall bladder disease
Osteomyelitis, septic arthritis
Transfusion history
Surgical history, splenectomy
Vaccination history, including Prevnar status
Medications:
- Penicillin prophylaxis
- Hydroxyurea
- Folic acid
- Pain medications
- Others
Allergies

Physical

General appearance, VS, pulse oximetry reading
Presence of CVC
Jaundice
Respiratory status
Circulatory status
Neurologic status
Evidence of focal infection
Spleen size
Presence of rash or petechiae

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Sickle Cell Disease with Fever Clinical Pathway – Emergency Department

History and Physical

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Sickle Cell Disease with Fever Clinical Pathway – Emergency Department – History and Physical

Sickle Cell Disease with Fever Clinical Pathway – Emergency Department

History and Physical