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Devisetty L, Smith S, Kuo IC. Satellite Faculty in an Academic Ophthalmology Department: Junior, Clinical, and Female. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:211-218. [PMID: 37188085 PMCID: PMC10181801 DOI: 10.1089/whr.2022.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 05/17/2023]
Abstract
Purpose To evaluate the perception of physicians at satellite offices of a large academic ophthalmology department. Methods A survey was sent to the 32 physician faculty members working at the satellite offices in the Ophthalmology Department of the University of Michigan. The ophthalmologists answered 44 survey questions on staffing, wait times, physician satisfaction, patient satisfaction, compensation, administrative help, research, and operations management. Results Seventeen (53%) satellite ophthalmologists responded. The majority were satisfied with work at satellites, which they felt operated efficiently and believed to feature high patient satisfaction. A minority of ophthalmologists had concerns about salary, volume, marketing support, and geographic location. Some respondents did not understand the compensation structure, satellites' finances, or contribution to the overall department. Most described a lack of research and resident teaching opportunities at satellites. Conclusions The perceptions of ophthalmologists who work in satellite offices are important because of the growth of these offices in academic medical centers and the ability for satellite doctors to offer care comparable with and sooner than doctors at the main hospital at locations convenient for patients. Satellite ophthalmologists at this academic center would appreciate increased transparency of compensation and financial structures; administrative help with marketing and maintaining efficiency, which doctors and patients enjoy at satellite offices; and more teaching and research opportunities, which are the basis of academic advancement. Such efforts may help retain satellite doctors, who tend to be junior in rank, female, nontenured faculty, and who experience a higher turnover rate than faculty at the main campus.
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Affiliation(s)
- Laxmi Devisetty
- Wilmer Eye Institute, Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shelby Smith
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Irene C. Kuo
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Address correspondence to: Irene C. Kuo, MD, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, 4924 Campbell Boulevard #100, Baltimore, MD 21236, USA.
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Lamont AE, Hsu LL, Jacobs S, Gibson R, Treadwell M, Chen Y, Lottenberg R, Axelrod K, Varughese T, Melvin C, Smith S, Chukwudozie IB, Kanter J. What does it mean to be affiliated with care?: Delphi consensus on the definition of "unaffiliation" and "specialist" in sickle cell disease. PLoS One 2022; 17:e0272204. [PMID: 36367870 PMCID: PMC9651581 DOI: 10.1371/journal.pone.0272204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Accruing evidence reveals best practices for how to help individuals living with Sickle Cell Disease (SCD); yet, the implementation of these evidence-based practices in healthcare settings is lacking. The Sickle Cell Disease Implementation Consortium (SCDIC) is a national consortium that uses implementation science to identify and address barriers to care in SCD. The SCDIC seeks to understand how and why patients become unaffiliated from care and determine strategies to identify and connect patients to care. A challenge, however, is the lack of agreed-upon definition for what it means to be unaffiliated and what it means to be a "SCD expert provider". In this study, we conducted a Delphi process to obtain expert consensus on what it means to be an "unaffiliated patient" with SCD and to define an "SCD specialist," as no standard definition is available. Twenty-eight SCD experts participated in three rounds of questions. Consensus was defined as 80% or more of respondents agreeing. Experts reached consensus that an individual with SCD who is unaffiliated from care is "someone who has not been seen by a sickle cell specialist in at least a year." A sickle cell specialist was defined as someone with knowledge and experience in SCD. Having "knowledge" means: being knowledgeable of the 2014 NIH Guidelines, "Evidence-Based Management of SCD", trained in hydroxyurea management and transfusions, trained on screening for organ damage in SCD, trained in pain management and on SCD emergencies, and is aware of psychosocial and cognitive issues in SCD. Experiences that are expected of a SCD specialist include experience working with SCD patients, mentored by a SCD specialist, regular attendance at SCD conferences, and obtains continuing medical education on SCD every 2 years." The results have strong implications for future research, practice, and policy related to SCD by helping to lay a foundation for an new area of research (e.g., to identify subpopulations of unaffiliation and targeted interventions) and policies that support reaffiliation and increase accessibility to quality care.
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Affiliation(s)
| | - Lewis L. Hsu
- University of Illinois, Chicago, Illinois, United States of America
| | - Sara Jacobs
- RTI International, Research Triangle Park, NC, United States of America
| | - Robert Gibson
- Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Marsha Treadwell
- UCSF School of Medicine, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Yumei Chen
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | | | - Kathleen Axelrod
- RTI International, Research Triangle Park, NC, United States of America
| | - Taniya Varughese
- Washington University St Louis, St. Louis MO, United States of America
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Sharon Smith
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, United States of America
| | | | - Julie Kanter
- University of Alabama, Birmingham, Birmingham, AL, United States of America
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3
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Binding A. Bringing Sickle Cell Disease Care Closer to Home: Feasibility and Efficacy of a Quality Improvement Initiative at a Community Hospital. Hemoglobin 2022; 46:91-94. [PMID: 35549807 DOI: 10.1080/03630269.2022.2073888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Comprehensive care for patients with sickle cell disease has been shown to improve morbidity. However, few studies have focused on community hospitals where the burden of disease is highest. From 2017 to 2019, a series of quality improvement interventions was implemented in Brampton, Toronto, ON, Canada, directed toward pediatric and adult sickle cell disease populations. This included a new adult clinic and education directed at patients and healthcare providers. There were 206 visits from 88 unique patients at the clinic and hydroxyurea (HU) uptake increased from 41.0 to 60.0% over that time (p < 0.001). The annual admission rate by adult patients before and after intervention was 90.0 and 75.0% respectively (p = 0.010). The length of stay of pediatric patients decreased from 3.5 to 2.9 days (p = 0.039). These interventions resulted in significant improvements in acute care utilization and HU use by sickle cell disease patients locally, but larger studies are required to confirm these findings.
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Affiliation(s)
- Andrew Binding
- Department of Medicine, William Osler Health System, Brampton, ON, Canada.,University Health Network, University of Toronto, Toronto, ON, Canada
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Shaner S, Hilliard L, Howard T, Pernell B, Bhatia S, Lebensburger J. Impact of telehealth visits on hydroxyurea response in sickle cell anemia. Pediatr Blood Cancer 2021; 68:e29354. [PMID: 34532949 DOI: 10.1002/pbc.29354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is important to ensure access to hydroxyurea (HU) for patients with sickle cell anemia (SCA) living in rural areas. The University of Alabama at Birmingham (UAB) Pediatric Sickle Cell program's satellite clinics reduce the barrier of transportation to the university-based clinic. However, as compared with the university clinic, these satellite clinics do not offer immediate access to HU dosing laboratory results and a nurse clinician calls families with HU dose adjustments after the clinic visit. This study evaluated the impact of telehealth dosing adjustments on HU laboratory and clinical response as compared with university-based patients. METHODS A one-year retrospective chart review was performed to evaluate HU laboratory and clinical response based on clinic location and socioeconomic status for patients with SCA. We identified the number of clinic and acute care visits for one year and calculated the mean complete blood count and fetal hemoglobin (HbF) values for each patient. RESULTS We identified 107 academic center participants with SCA-prescribed HU and 65 satellite clinic participants. The mean age of participants was 11 ± 5 years. We identified no difference in HbF (13.3 ± 0.7 vs 11.7 ± 0.8, P = 0.13), Hb (8.46 ± 1.1 vs 8.55 ± 1.1, P = 0.59), mean corpuscular volume (91.0 ± 10.6 vs 91.7 ± 9.5, P = 0.67), or absolute neutrophil count (4.85 ± 2.3 vs 4.87 ± 2.3, P = 0.95) when comparing Birmingham versus satellite clinics. We also identified no difference in hospital admissions (0.99 ± 0.1 versus 0.85 ± 0.2, P = 0.49), based on clinic location. CONCLUSIONS The use of telehealth did not negatively impact laboratory response to HU. Future studies should identify novel approaches to improve access to HU among patients with SCA living in rural areas.
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Affiliation(s)
- Sarah Shaner
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Lee Hilliard
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas Howard
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brandi Pernell
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Smita Bhatia
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey Lebensburger
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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Kanter J, Phillips S, Schlenz A, Mueller M, Dooley M, Sirline L, Nickel R, Brown RC, Hilliard L, Melvin C, Adams R. Transcranial Doppler Screening in a Current Cohort of Children With Sickle Cell Anemia: Results From the DISPLACE Study. J Pediatr Hematol Oncol 2021; 43:e1062-e1068. [PMID: 33625093 PMCID: PMC8481351 DOI: 10.1097/mph.0000000000002103] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
Stroke prevention guidelines for sickle cell anemia (SCA) recommend transcranial Doppler (TCD) screening to identify children at stroke risk; however, TCD screening implementation remains poor. This report describes results from Part 1 of the 28-site DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study, a baseline assessment of TCD implementation rates. This report describes TCD implementation by consortium site characteristics; characteristics of TCDs completed; and TCD results based on age. The cohort included 5247 children with SCA, of whom 5116 were eligible for TCD implementation assessment for at least 1 study year. The majority of children were African American or Black, non-Hispanic and received Medicaid. Mean age at first recorded TCD was 5.9 and 10.5 years at study end. Observed TCD screening rates were unsatisfactory across geographic regions (mean 49.9%; range: 30.9% to 74.7%) independent of size, institution type, or previous stroke prevention trial participation. The abnormal TCD rate was 2.9%, with a median age of 6.3 years for first abnormal TCD result. Findings highlight real-world TCD screening practices and results from the largest SCA cohort to date. Data informed the part 3 implementation study for improving stroke screening and findings may inform clinical practice improvements.
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Affiliation(s)
- Julie Kanter
- Division of Hematology & Oncology, University of Alabama Birmingham
| | | | - Alyssa Schlenz
- Department of Pediatrics, University of Colorado School of Medicine
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina
- Department of Public Health Sciences, Medical University of South Carolina
| | - Mary Dooley
- College of Nursing, Medical University of South Carolina
| | - Logan Sirline
- Department of Public Health Sciences, Medical University of South Carolina
| | - Robert Nickel
- Divison of Hematology-Oncology, Children’s National Medical Center
| | - R. Clark Brown
- Aflac Cancer and Blood Disorder Center, Emory University
| | | | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina
| | - Robert Adams
- Department of Neurology and Neurosurgery, Medical University of South Carolina
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6
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Phillips SM, Schlenz AM, Mueller M, Melvin CL, Adams RJ, Kanter J. Identified barriers and facilitators to stroke risk screening in children with sickle cell anemia: results from the DISPLACE consortium. Implement Sci Commun 2021; 2:87. [PMID: 34376249 PMCID: PMC8353775 DOI: 10.1186/s43058-021-00192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children with sickle cell anemia are at risk for stroke. Ischemic stroke risk can be identified among children ages 2–16 years with sickle cell anemia using transcranial Doppler ultrasound. Despite strong recommendations for transcranial Doppler screening in guidelines released by the National Heart, Lung, and Blood Institute, implementation of transcranial Doppler screening in sickle cell anemia remains suboptimal. The purpose of this study was to identify barriers and facilitators to transcranial Doppler screening in a large national consortium to inform subsequent implementation interventions. Methods A qualitative descriptive approach was used to conduct 52 semi-structured interviews with a sample of patients with sickle cell anemia, their parents or primary caregivers, and healthcare providers dispersed across the United States. Interviews took place from September 2018 through March 2019. Directed content analysis was conducted with an adapted version of the Multilevel Ecological Model of Health as an initial coding framework, completed July 2019. Frequency analysis was conducted to determine predominant barrier and facilitator themes. Results Fourteen barrier themes and 12 facilitator themes emerged representing all levels of the ecological framework. Two barrier themes (Logistical Difficulties and Competing Life Demands and Gaps in Scheduling and Coordination), and 5 facilitator themes (Coordination, Scheduling and Reminders; Education and Information; Provider and Staff Investment and Assistance; Positive Patient Experience; and Convenient Location) were predominant. Conclusions Barriers and facilitators to transcranial Doppler screening in children with sickle cell anemia are complex and occur across multiple ecological levels. One barrier theme and 3 facilitator themes were found to be optimal to address in subsequent implementation interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00192-z.
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Affiliation(s)
- Shannon M Phillips
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, USA.
| | - Alyssa M Schlenz
- Department of Pediatrics, Medical University of South Carolina, Charleston, USA.,Department of Pediatrics, University of Colorado School of Medicine, 1800 Grant St. Suite 800, Denver, CO, 80203, USA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Julie Kanter
- Division of Hematology & Oncology, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL, 35294, USA
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Olupot-Olupot P, Wabwire H, Ndila C, Adong R, Ochen L, Amorut D, Abongo G, Okalebo CB, Akello SR, Oketcho JB, Okiror W, Asio S, Odiit A, Alaroker F, Nyutu G, Maitland K, Williams TN. Characterising demographics, knowledge, practices and clinical care among patients attending sickle cell disease clinics in Eastern Uganda. Wellcome Open Res 2020; 5:87. [PMID: 32802962 PMCID: PMC7406951 DOI: 10.12688/wellcomeopenres.15847.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background: In Uganda to date, there are neither established registries nor descriptions of facility-based sickle cell disease (SCD) patient characteristics beyond the central region. Here, we summarize data on the baseline clinical characteristics and routine care available to patients at four clinics in Eastern Uganda as a prelude to a clinical trial. Methods: Between February and August 2018, we conducted a cross-sectional survey of patients attending four SCD clinics in Mbale, Soroti, Atutur and Ngora, all in Eastern Uganda, the planned sites for an upcoming clinical trial (H-PRIME: ISRCTN15724013). Data on socio-demographic characteristics, diagnostic methods, clinic schedules, the use of prophylactic and therapeutic drugs, clinical complications and patient understanding of SCD were collected using a structured questionnaire. Results: Data were collected on 1829 patients. Their ages ranged from 0 to 64 years with a median (IQR) of 6 (3-11) years. 49.1% of participants were male. The majority (1151; 62.9%) reported a positive family history for SCD. Approximately half knew that SCD is inherited from both parents but a substantial proportion did not know how SCD is transmitted and small numbers believed that it is acquired by either transfusion or from other people. Only 118/1819 (6.5%) participants had heard about or were using hydroxyurea while 356/1794 (19.8%) reported stigmatization. Participants reported a median of three (IQR 1-4) hospital admissions during the preceding 12 months; 80.8% had been admitted at least once, while 14.2% had been admitted more than five times. Pain was the most common symptom, while 83.9% of those admitted had received at least one blood transfusion. Conclusion: The majority of patients attending SCD clinics in Eastern Uganda are children and few are currently being treated with hydroxyurea. The data collected through this facility-based survey will provide background data that will be useful in planning for the H-PRIME trial.
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Affiliation(s)
- Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ham Wabwire
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | - Ruth Adong
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Linus Ochen
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Denis Amorut
- Mbale Clinical Research Institute, Mbale, Uganda
- Soroti Regional Referral Hospital, Soroti, Uganda
| | - Grace Abongo
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | | | | | | | - Sarah Asio
- Atutur District Hospital, Atutur, Uganda
| | - Amos Odiit
- Ngora Freda Carr Hospital, Ngora, Uganda
| | | | - Gideon Nyutu
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kathryn Maitland
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College London, London, UK
| | - Thomas N. Williams
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College London, London, UK
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Olupot-Olupot P, Wabwire H, Ndila C, Adong R, Ochen L, Amorut D, Abongo G, Okalebo CB, Akello SR, Oketcho JB, Okiror W, Asio S, Odiit A, Alaroker F, Nyutu G, Maitland K, Williams TN. Characterising demographics, knowledge, practices and clinical care among patients attending sickle cell disease clinics in Eastern Uganda. Wellcome Open Res 2020; 5:87. [PMID: 32802962 PMCID: PMC7406951 DOI: 10.12688/wellcomeopenres.15847.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 03/30/2024] Open
Abstract
Background: In Uganda to date, there are neither established registries nor descriptions of facility-based sickle cell disease (SCD) patient characteristics beyond the central region. Here, we summarize data on the baseline clinical characteristics and routine care available to patients at four clinics in Eastern Uganda as a prelude to a clinical trial. Methods: Between February and August 2018, we conducted a cross-sectional survey of patients attending four SCD clinics in Mbale, Soroti, Atutur and Ngora, all in Eastern Uganda, the planned sites for an upcoming clinical trial (H-PRIME: ISRCTN15724013). Data on socio-demographic characteristics, diagnostic methods, clinic schedules, the use of prophylactic and therapeutic drugs, clinical complications and patient understanding of SCD were collected using a structured questionnaire. Results: Data were collected on 1829 patients. Their ages ranged from 0 to 64 years with a median (IQR) of 6 (3-11) years. 50.9% of participants were male. The majority (1151; 62.9%) reported a positive family history for SCD. Approximately half knew that SCD is inherited from both parents but a substantial proportion did not know how SCD is transmitted and small numbers believed that it is acquired by either transfusion or from other people. Only 118/1819 (6.5%) participants had heard about or were using hydroxyurea while 356/1794 (19.8%) reported stigmatization. Participants reported a median of three (IQR 1-4) hospital admissions during the preceding 12 months; 80.8% had been admitted at least once, while 14.2% had been admitted more than five times. Pain was the most common symptom, while 83.9% of those admitted had received at least one blood transfusion. Conclusion: The majority of patients attending SCD clinics in Eastern Uganda are children and few are currently being treated with hydroxyurea. The data collected through this facility-based survey will provide background data that will be useful in planning for the H-PRIME trial.
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Affiliation(s)
- Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ham Wabwire
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | - Ruth Adong
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Linus Ochen
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Denis Amorut
- Mbale Clinical Research Institute, Mbale, Uganda
- Soroti Regional Referral Hospital, Soroti, Uganda
| | - Grace Abongo
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | | | | | | | - Sarah Asio
- Atutur District Hospital, Atutur, Uganda
| | - Amos Odiit
- Ngora Freda Carr Hospital, Ngora, Uganda
| | | | - Gideon Nyutu
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kathryn Maitland
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College London, London, UK
| | - Thomas N. Williams
- Mbale Clinical Research Institute, Mbale, Uganda
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College London, London, UK
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Sirigaddi K, Aban I, Jantz A, Pernell BM, Hilliard LM, Bhatia S, Lebensburger JD. Outcomes of febrile events in pediatric patients with sickle cell anemia. Pediatr Blood Cancer 2018; 65:e27379. [PMID: 30070043 PMCID: PMC6150798 DOI: 10.1002/pbc.27379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/12/2018] [Accepted: 06/29/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited evidence exists to create institutional admission criteria guidelines for febrile sickle cell patients. In addition, evidence is lacking to understand readmission rates for febrile sickle cell patients discharged from the emergency department (ED) or hospital. PROCEDURES We conducted a 16-year retrospective study of bacteremia outcomes for febrile sickle cell patients. Risk variables analyzed included fever (either ≥ 39.5°C or ≥40°C), abnormal white blood cell (WBC) (>30,000 or <5,000/mcL), tachycardia and hypotension, or "ill appearing." Fourteen-day readmission rates were analyzed to determine outcomes for febrile sickle cell patients discharged from the ED or discharged within 72 h. RESULTS Bacteremia was identified in 17 (2.6%) of 653 febrile events that are presented to the ED. "Ill-appearing" patients had an 8.5-fold increased odds of being diagnosed with bacteremia. Models using WBC count, "ill appearing," and hypotension have the highest sensitivity and specificity (AUC > 0.75). Among 427 patients discharged from the ED or within 72 h of hospitalization, only 10 (2.3%) were readmitted for a new sickle cell complication. CONCLUSIONS Institutions can develop admission criteria based on WBC count, hypotension, and "ill appearance." Persistently febrile, well-appearing patient can be discharged at 48 h with minimal risk for new complications.
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Affiliation(s)
| | - Inmaculada Aban
- University of Alabama at Birmingham, Department of Biostatistics
| | - Amelia Jantz
- University of Alabama at Birmingham, Division of Pediatric Hematology Oncology
| | - Brandi M. Pernell
- University of Alabama at Birmingham, Division of Pediatric Hematology Oncology
| | - Lee M. Hilliard
- University of Alabama at Birmingham, Division of Pediatric Hematology Oncology
| | - Smita Bhatia
- University of Alabama at Birmingham, Division of Pediatric Hematology Oncology
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