Emergency Department Management of Acute Pediatric Sickle Cell Disease Complications

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Publication Date: November 2024 (Volume 21, Number 11)

CME Credits:  4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 11/01/2027.

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Peer Reviewers

Abstract

The complications of sickle cell disease (SCD) in pediatric patients are some of the more common chronic conditions that present to the emergency department. It is important that emergency clinicians understand the features of SCD, its related complications, and the associated diagnostic and therapeutic modalities to provide this patient population with the most evidence-based and high-quality care. This review describes the acute complications and evidence-based emergent management of SCD in pediatric patients.

Case Presentations

A 15-year-old boy with sickle cell disease presents with cough, congestion, and fever...

• The boy's symptoms have progressed over 2 days, with a temperature of 38.9°C starting 1 hour ago.
• The boy's vital signs are: heart rate, 120 beats/min; respiratory rate, 29 breaths/min; and oxygen saturation, 88% on room air. Auscultation reveals decreased breath sounds in the right lower lobe. Chest x-ray shows a right lower lobe infiltrate. You place the boy on a nasal cannula for oxygen support.
• What is the differential diagnosis? How should you manage this patient?

A 2-year-old girl with sickle cell disease presents with fatigue and pallor over the past several days...

• The girl is lying on her mother's lap. Her vital signs are: heart rate, 159 beats/min; respiratory rate, 22 breaths/min; and oxygen saturation, 98% on room air.
• On examination, she has a distended abdomen and a palpable splenic edge.
• What is the most concerning diagnosis for this patient?

A 14-year-old boy with sickle cell disease presents to the ED stating that he has severe bilateral thigh and shoulder pain that worsened after football practice...

• On examination, the boy has normal vital signs and appears to be in pain. He reports moderate pain when his right shoulder and thighs are palpated. He tried ibuprofen and hydrocodone-acetaminophen at home, without improvement. No other known trauma is reported.
• What is the differential diagnosis? How should you manage this patient?

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