Considering Outpatient Management of Febrile Patients with Sickle Cell Disease

Previous studies indicate that febrile children with sickle cell disease (SCD) have a 3% to 5% risk for bacteremia owing to their compromised splenic function. Subsequent risks for sepsis, septic shock, and death have made emergent care, lab studies, and admission for antibiotic therapy and observation the rule for most patients. Researchers at Boston's Children's Hospital retrospectively reviewed all febrile patients with SCD presenting to the emergency department (ED) from 1993 through 2010, excluding patients with temperatures ≤38.5°C, no culture results or medical records, or previous febrile visit or antibiotics.

Among 1118 children included in the analysis, 9 specimens (0.8%) grew bacteremia (Salmonella, 4; Streptococcus pneumoniae, 2;…