Consider admission if one or more of the following are present |
Clinical findings | Temperature >40°C (>104°F) |
Persistent tachycardia, hypotension, increased respiratory rate for age*, SaO2 <3% below baseline, hypoperfusion |
Indwelling central venous catheter, port, or PICC |
Suspected or confirmed acute chest syndrome |
Suspected meningitis |
Additional acute complications of SCD such as - Stroke
- Pain
- Aplastic crisis
- Splenic sequestration
|
Dehydration that cannot be corrected by oral intake |
Concern about length/duration of empiric antibiotic coverage (antibiotics other than ceftriaxone)¶ |
Laboratory findings | WBC count - >30,000/microL
- If not taking hydroxyurea: WBC <5000/microL
- If taking hydroxyurea: ANC <500/microL (ANC <1000/microL if ill-appearing)
|
Hemoglobin - <5 g/dL
- Decreased by ≥2 g/dL from the individual's baseline
|
Platelet countΔ - <100,000/microL (if baseline is normal)
- Decreased by ≥20,000/microL (if baseline is <100,000/microL)
|
History and social considerations | Prior history of sepsis or bacteremia, particularly with Strep. pneumoniae |
Immunizations not up to date |
Nonadherence to prophylactic penicillin, if prescribed |
Concern about parent/family/caregiver ability to identify changes should the patient's clinical status deteriorate |
Concern about ability to return to the emergency department if needed |
Inability to reliably contact the patient/family/caregiver if blood cultures turn positive (lack of telephone, lack of transportation) |