PEM JOURNAL CLUB: SICKLE CELL With FEVER PROTOCOL

Hello!
This journal club we reviewed the PED sickle cell with fever protocol. Below are the highlights from that protocol that we found to be the most important steps of the protocol that also had some evidence behind them in the articles listed below. (BTW in the first article Gibbs is one of the authors!)

Hope you enjoy!
- Kat   

• Labs
  • PEM Consensus:
    • CBC, Retic panel to evaluate for aplastic crisis or splenic sequestration
    • Blood culture
• Treatment
  • PEM Consensus:
    • Avoid oxygen unless in respiratory distress
    • IV bolus ONLY if clinically dehydrated/hypotensive
      • Excess IVF are associated with atelectasis formation, which is a risk factor for acute chest syndrome
    • Early administration of IV antibiotics covering Strep pneumoniae crucial
      • Majority of bacterial infections from encapsulated bacteria
      • Use high dose Ceftriaxone (75mg/kg – 100mg/kg, Max 2G) for higher serum levels
        • SCD patient with higher risk for antibiotic resistance
        • If (true) PCN allergy: Clindamycin 15mg/kg (Max 600mg)
        • If severe illness or meningitis: add Vancomycin (15mg/kg)
• Disposition
  • PEM Consensus:
    • Higher likelihood of admission based on age and ability for follow-up
    • Contact Hematologist for disposition joint decision
• Strength of recommendations
  • PEM Consensus:
    • WEAK
      • SCD severely underfunded
      • Large portion of research preformed before wide availability of Pneumococcal vaccine
      • No high powered studies performed/published in several decades
• Articles
  
  • Glassberg, J. "Evidence-based management of sickle cell disease in the emergency department." Emergency medicine practice 13.8 (2011): 1-20.
  • Yawn, Barbara P., et al. "Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members." Jama 312.10 (2014): 1033-1048.
  • Powars, Darleen, et al. "Pneumococcal septicemia in children with sickle cell anemia: changing trend of survival." JAMA 245.18 (1981): 1839-1842.
  • Overturf, Gary D., Darleen Powars, and Larry J. Baraff. "Bacterial meningitis and septicemia in sickle cell disease." American Journal of Diseases of Children 131.7 (1977): 784-787.
  • Yusuf HR, Atrash HK, Grosse SD, Parker CS, Grant AM. Emergency department visits made by patients with sickle cell disease: a descriptive study, 1999–2007. American journal of preventive medicine. 2010;38(4):S536-S41.
  • Yawn BP, Buchanan GR, Afenyi-Annan AN, Ballas SK, Hassell KL, James AH, et al. Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA. 2014;312(10):1033-48.