Diagnostic Algorithm to Reduce Hospitalization for Children with Sickle Cell Disease

Sickle cell disease is a hereditary condition that affects red blood cells, causing them to take on a sickle shape, which can obstruct blood flow to various parts of the body. This disorder predominantly affects individuals of African descent. According to the National Heart, Lung, and Blood Institute, those living with sickle cell disease endure lifelong health challenges, including chronic pain, lung complications, and impaired spleen function. Children with sickle cell disease are particularly vulnerable to infections, making vigilant monitoring essential. Traditionally, any child under 2 years of age with sickle cell disease presenting to the Emergency Department (ED) with a fever was admitted immediately. This approach led to numerous unnecessary hospitalizations, which placed a strain on both families and healthcare systems, consuming valuable time and resources. Now, a new algorithm has been developed to streamline care for children with sickle cell disease who present with a fever, aiming to reduce unnecessary hospital stays.

A collaborative effort at the Medical University of South Carolina (MUSC, Charleston, SC, USA) led to the creation of a diagnostic algorithm designed to guide decisions about whether to admit or discharge a pediatric patient with sickle cell disease and fever. The goal was to safely discharge patients who could recover at home with appropriate follow-up care. Under this new protocol, emergency physicians at MUSC Shawn Jenkins Children’s Hospital work closely with the hematology/oncology team to assess patients’ risk levels, with the recommendation that low-risk patients be treated as outpatients. This algorithm provides a standardized and consistent approach to care, potentially reducing hospital admissions. After implementing the algorithm for one year, the research team compared the admission data with that of the previous year and found a 10% decrease in admissions without any increase in readmission rates.

While the findings, published in the Journal of Pediatric Hematology and Oncology, were not statistically significant, they suggest that low-risk patients could safely be managed as outpatients, with close follow-up proving to be effective. The interdisciplinary team dedicated considerable time and effort to developing and testing this tool, and they are encouraged by the results, confident that the standardized protocol will have a positive impact on patient care. The algorithm continues to be used and evaluated at MUSC Children’s Health, demonstrating the power of collaborative efforts and showing that enhanced patient care does not need to come at a high cost.

“Your spleen does a lot of things,” said first author Jason Erno, M.D. “One of the most important is to help to prevent infections. These kids are susceptible to more severe infections than your average kid, which is why it can be so scary when they get sick. Having the algorithm makes everybody feel a little more comfortable that we’re doing the right thing.”