43 - Sickle Cell Disease Children with Fever Managed with a single ED visit and telephone follow-up

Poster Number: 43

Evelyne D.Trottier, CHU Sainte-Justine, Montreal, PQ, Canada; Celine Rolle, Hôpital universitaire Robert Debré, Paris, Ile-de-France, France; Benoit Bailey, CHU Sainte-Justine, Montreal, PQ, Canada; Philippe Ovetchkine, University of Montreal, Montreal, PQ, Canada; Yves D. Pastore, CHU Sainte-Justine, MONTREAL, PQ, Canada; Julie Autmizguine, Universite de Montreal Faculty of Medicine, Montrral, PQ, Canada; Nancy Robitaille, CHU Sainte-Justine, Montreal, PQ, Canada; Hugo Paquin, CHU Sainte-Justine, Montreal, PQ, Canada; Nathalie Fournier, chus, Chambly, PQ, Canada

Background: Reducing unnecessary visits for children with sickle cell disease (SCD) may improve their quality of life.

Objective: The aim of this study was to evaluate the success of our local guideline for low-risk children with SCD presenting to the ED with a febrile episode, managed with a single outpatient visit and systematic telephone follow-up.

Design/Methods: This was a single center retrospective observational study of children with SCD presenting with fever to the ED of a pediatric tertiary care hospital. Since 2012, a multidisciplinary team, the DrépaNoPain group, works to improve acute management of patients with SCD in the institution. In 2016, a new guideline was implemented for fever, while patients at low-risk of severe infection, in agreement to the 2018 CanHaem statement, are discharged after evaluation and a dose of ceftriaxone. The next day, they receive a telephone follow-up instead of regular follow-up visit in haematology clinic.

Medical records were reviewed for all 6 months-18 yo patients with SCD seen one year before (2015) and three years after (2019) the implementation of the single visit guideline for low-risk patient. To evaluate the success of this guideline, we aimed to determine the reduction rate of a second medical visit in clinic. We also evaluated unscheduled medical return visits within 72h as well as failure to do a telephone follow up. The rate of bacteremia and invasive infections were reported.

Results: We reviewed 186 episodes of patients who visited the ED in the pre-cohort and 185 in post-cohort. From those cohorts, 26/186 (14%) and 25/185 (14%) were excluded (no fever or no SCD), leaving 160 patients in each group for analysis. From those, 96/160 (60%) patients in the pre and 111/160 (69%) in the post-cohort were discharge from the ED after their initial visit and were included for this study, a difference of 9 (95 CI -1, 20). Their median age was 5 (IQR 1, 8) and 3 (IQR 2, 7).

In the pre-cohort, 93/96 (97%) had a follow-up visit in clinic compared to 11/111 (10%) in the post-cohort, a reduction rate of 87% (95% CI 78, 92). Also, 9/96 (9%) and 1/111 (1%) had unplanned visit in the ED or at the haematology clinic, a difference of 8% (95% CI 2, 16). For the scheduled telephone follow-up in the post-cohort, 29/100 (29%) were not reached. No sepsis was reported among the discharged patients.Conclusion(s): A single ED visit for low-risk children with SCD and telephone follow-up was successful at reducing follow-up visit in clinic for more than 85% of discharged patients. This novel approach appears secure, but improvement is required to reduce failure at telephone follow-up.
Figure 1: Timeline of study
Table 1: Patients discharged from the ED pre and post guideline