G244(P) Treatment of fever in children with sickle cell disease. (25th October 2020)

• Record Type: Journal Article
• Authors: Ravindran, S; Chakravorty, S; Mitchell, R
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 1
• Page Start: A89
• Page End: A89
• Publication Date: 2020-10-25
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-rcpch.211
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Fever is an important sign in children with sickle cell disease (SCD), often being the only indicator of serious and potentially life-threatening secondary bacterial infection. Treatment of febrile children with SCD in our Paediatric Emergency Department (PED) can be variable, including escalation of care of those who are unwell and pragmatic management of those who are well. We therefore audited the management of fever with SCD presenting to PED and developed guidance to aid management, particularly looking at whether ambulatory nursing teams can be utilised to manage 'low-risk' patients. Methods: We analysed the management of SCD children presenting to PED with fever over a one year period. Using these results, we developed guidance for febrile children with SCD, based on risk stratification. Results: 28 children with SCD presented between July 2018 – July 2019, of whom 22 were admitted and 6 discharged from PED. Diagnoses among these patients are displayed in table 1 . Antibiotic treatment was consistent in the management of fever due to acute chest syndrome, but was otherwise variable. One third of children discharged (2/6) received oral antibiotic treatment to complete at home. None of the discharged children were referred to the ambulatory nursing team for review. Subsequently we developed guidance to standardise clinical assessment, direct antibiotic choice, give clear risk-stratification criteria and advice on management of low-risk fevers of SCD children in the community. Conclusions: Fever may indicate serious bacterial infection in children with SCD, requiring prompt and specific antibiotic treatment. Implementation of a guideline will help tailor treatment to the most likely cause of fever and risk-stratify these children accordingly. Utilisation of ambulatory nursing teams should be encouraged to promote admission avoidance and ensure low-risk children can be managed safely at home.