{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T02:50:49Z","timestamp":1794279049170,"version":"4.9.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T00:00:00Z","timestamp":1686528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Sickle Cell Disease (SCD) is highly prevalent in Saudi Arabia with variable demographics and access to health care facilities including emergency departments. Literature reviews for locally published articles are deficient in the in-depth evaluation of current emergency practices in managing patients with SCD. The study aims to assess the current emergency practice in managing SCD patients in tertiary hospitals. We reviewed data of 212 visits by patients with SCD over three years and assessed the current emergency department practices in managing common SCD crises, such as vaso-occlusive (VOC) and febrile episodes. Our findings revealed that 47.2%, 37.7%, and 15% of the patients presented with pain, fever, or both, respectively. The patients were triaged level III according to the Canadian triage and acuity scale system in 89% of the visits. The Median time for patients to see healthcare providers was 22\u2005min. In the first 2\u2005h, 86% of the patients received at least one fluid bolus and 79% of them received appropriate analgesia for pain crises. Approximately 41.5% of the patients with fever were admitted and received ceftriaxone as single intravenous antimicrobial agent. However, none of the patients had bacteremia. Only 2.4% of the patients had either urinary tract infection or osteomyelitis based on imaging.<\/jats:p><jats:p>ED management is a key factor in the successful management of patients with SCD in a timely manner by providing fluids, analgesia, and antibiotics. Adopting evidence-based guidelines and avoiding unnecessary admissions are suggested in clinically well patients with fever in the era of completed vaccination, antibiotic prophylaxis, and good access to care for patients with a clear viral infection focus.<\/jats:p>","DOI":"10.3389\/fped.2023.1195040","type":"journal-article","created":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T04:24:17Z","timestamp":1686543857000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Management of fever and acute painful crises in children with sickle cell disease in emergency departments: a tertiary hospital experience"],"prefix":"10.3389","volume":"11","author":[{"given":"Tameem","family":"Almahmoud","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasneem","family":"Alnashwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Al Kuhaimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed F.","family":"Essa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nouf","family":"Al Balawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled Al","family":"Jamaan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesrin","family":"Al-Harthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/B978-0-12-802973-2.00018-5","article-title":"Sickle cell disease","volume":"138","author":"Strouse","year":"2016","journal-title":"Handb Clin Neurol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1038\/198492b0","article-title":"Distribution of sickle-cell haemoglobin in Saudi Arabia","volume":"198","author":"Lehmann","year":"1963","journal-title":"Nature"},{"key":"B3","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1111\/petr.12767","article-title":"Demands and challenges for patients with sickle-cell disease requiring hematopoietic stem cell transplantation in Saudi Arabia","volume":"20","author":"Alsultan","year":"2016","journal-title":"Pediatr Transplant"},{"key":"B4","first-page":"1","article-title":"Evidence-based management of sickle cell disease in the emergency department","volume":"13","author":"Glassberg","year":"2011","journal-title":"Emerg Med Pract"},{"key":"B5","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1093\/jpepsy\/26.4.203","article-title":"Multidimensional assessment of pain in pediatric sickle cell disease","volume":"26","author":"Graumlich","year":"2001","journal-title":"J Pediatr Psychol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/s0027-9684(15)30471-5","article-title":"Patient-reported outcomes: descriptors of nociceptive and neuropathic pain and barriers to effective pain management in adult outpatients with sickle cell disease","volume":"102","author":"Wilkie","year":"2010","journal-title":"J Natl Med Assoc"},{"key":"B7","doi-asserted-by":"publisher","first-page":"262","DOI":"10.4236\/ojped.2014.44036","article-title":"Fever among children with sickle-cell disease: findings from the general pediatric ward of the owendo pediatric hospital in Libreville, Gabon","volume":"4","author":"Koko","year":"2014","journal-title":"Open J Pediatr"},{"key":"B8","first-page":"1069","article-title":"Management of sickle cell disease: recommendations from the 2014 expert panel report","volume":"92","author":"Yawn","year":"2015","journal-title":"Am Fam Physician"},{"key":"B9","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1016\/S0022-3476(95)70107-9","article-title":"Penicillin-and cephalosporin-resistant strains of Streptococcus pneumoniae causing sepsis and meningitis in children with sickle cell disease","volume":"127","author":"Chesney","year":"1995","journal-title":"J Pediatr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1542\/peds.2012-2139","article-title":"Bacteremia risk and outpatient management of febrile patients with sickle cell disease","volume":"131","author":"Baskin","year":"2013","journal-title":"Pediatrics"},{"key":"B11","first-page":"1480","article-title":"The prevalence of sickle cell disease in Saudi children and adolescents. A community-based survey","volume":"29","author":"Al-Qurashi","year":"2008","journal-title":"Saudi Med J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"226","DOI":"10.21767\/2386-5180.1000226","article-title":"Prevalence of complications of sickle cell disease at Makkah Al-Mukaramah, Saudi Arabia, 2017","volume":"6","author":"Alkot","year":"2018","journal-title":"Ann Clin Lab Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1111\/j.1365-2141.1991.tb08013.x","article-title":"Two different forms of homozygous sickle cell disease occur in Saudi Arabia","volume":"79","author":"Padmos","year":"1991","journal-title":"Br J Haematol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"E412","DOI":"10.1002\/ajh.26696","article-title":"Adherence to NHLBI guidelines for the emergent management of vaso-occlusive episodes in children with sickle cell disease: a multicenter perspective","volume":"97","author":"Rees","year":"2022","journal-title":"Am J Hematol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.annemergmed.2012.05.024","article-title":"Performance of the Canadian triage and acuity scale for children: a multicenter database study","volume":"61","author":"Gravel","year":"2013","journal-title":"Ann Emerg Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1001\/jama.2014.10517","article-title":"Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members","volume":"312","author":"Yawn","year":"2014","journal-title":"JAMA"},{"key":"B17","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1002\/ajh.23945","article-title":"Evidence gaps in the management of sickle cell disease: a summary of needed research","volume":"90","author":"Savage","year":"2015","journal-title":"Am J Hematol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJM199107043250103","article-title":"Pain in sickle cell disease: rates and risk factors","volume":"325","author":"Platt","year":"1991","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/j.annemergmed.2013.02.004","article-title":"Emergency provider analgesic practices and attitudes toward patients with sickle cell disease","volume":"62","author":"Glassberg","year":"2013","journal-title":"Ann Emerg Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1542\/peds.2008-0441","article-title":"Hydroxyurea for sickle cell disease: a systematic review for efficacy and toxicity in children","volume":"122","author":"Strouse","year":"2008","journal-title":"Pediatrics"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1517\/14740338.2015.1088827","article-title":"Hydroxyurea therapy for sickle cell anemia","volume":"14","author":"McGann","year":"2015","journal-title":"Expert Opin Drug Saf"},{"key":"B22","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1056\/NEJMoa1813598","article-title":"Hydroxyurea for children with sickle cell anemia in sub-Saharan Africa","volume":"380","author":"Tshilolo","year":"2019","journal-title":"N Engl J Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/j.ajem.2009.04.002","article-title":"Bacterial blood cultures in children with sickle cell disease","volume":"28","author":"Rogovik","year":"2010","journal-title":"Am J Emerg Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1097\/MPH.0000000000000070","article-title":"Predictors of bacteremia among children with sickle cell disease presenting with fever","volume":"36","author":"Savlov","year":"2014","journal-title":"J Pediatr Hematol Oncol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1097\/00043426-200205000-00012","article-title":"Predictors of bacteremia in febrile children with sickle cell disease","volume":"24","author":"West","year":"2002","journal-title":"J Pediatr Hematol Oncol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1542\/peds.2012-2139","article-title":"Bacteremia risk and outpatient management of febrile patients with sickle cell disease","volume":"131","author":"Baskin","year":"2013","journal-title":"Pediatrics"},{"key":"B27","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1056\/NEJM199308123290705","article-title":"A randomized study of outpatient treatment with ceftriaxone for selected febrile children with sickle cell disease","volume":"329","author":"Wilimas","year":"1993","journal-title":"N Engl J Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1002\/pbc.24887","article-title":"Respiratory syncytial virus and seasonal influenza cause similar illnesses in children with sickle cell disease","volume":"61","author":"Sadreameli","year":"2014","journal-title":"Pediatr Blood Cancer"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e28759","DOI":"10.1002\/pbc.28759","article-title":"The burden of respiratory syncytial virus infections among children with sickle cell disease","volume":"68","author":"Rostad","year":"2021","journal-title":"Pediatr Blood Cancer"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2656","DOI":"10.1182\/bloodadvances.2020001851","article-title":"American society of hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain","volume":"4","author":"Brandow","year":"2020","journal-title":"Blood Adv"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e28268","DOI":"10.1002\/pbc.28268","article-title":"The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain","volume":"67","author":"Muslu","year":"2020","journal-title":"Pediatr Blood Cancer"},{"key":"B32","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1002\/ajh.25471","article-title":"Normal saline bolus use in pediatric emergency departments is associated with poorer pain control in children with sickle cell anemia and vaso-occlusive pain","volume":"94","author":"Carden","year":"2019","journal-title":"Am J Hematol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1195040\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T04:24:24Z","timestamp":1686543864000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1195040\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,12]]},"references-count":32,"alternative-id":["10.3389\/fped.2023.1195040"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1195040","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,12]]},"article-number":"1195040"}}