Journal Club: Is outpatient management sufficient for some febrile patients with SCD?

The findings of a study that evaluated the implementation of a low-risk algorithm for outpatient management of febrile children with sickle cell disease (SCD) suggest that the answer to this question is yes. The algorithm established a risk criteria assessment of clinical, laboratory, past medical history, and social history parameters.

Investigators conducted a retrospective 2-year review of patients with SCD younger than 18 years with a temperature of at least 101 ºF who visited an emergency department during the year before the algorithm was implemented and the year following implementation. Of the patients who were admitted, 55% presented before the algorithm was implemented, compared with 43.6% who were admitted after its implementation. In addition, once the standardized pathway was implemented, readmissions decreased, especially at 14 to 30 days after discharge. However, the length of hospital stay for patients admitted did not differ between the 2 years, nor did the incidence of SCD complications.

THOUGHTS FROM DR FARBER

We admit patients with SCD and fever who, in retrospect, do not require hospitalization, but we lack a solid method for determining who fits in this category. The study did not show a statistically significant decrease in admissions, but following the protocol included with the article did allow more children to be treated safely at home.

Reference

Erno J, Noisette L, Bergmann S, et al. Implementation of a low-risk algorithm for outpatient management of febrile pediatric patients with sickle cell disease. J Pediatr Hematol Oncol. 2025;47(2):80-85. doi:10.1097/MPH.0000000000002992