Paediatric Emergency Department use and risk factors for admission in Sickle Cell Disease Children in a country without comprehensive care

Introduction. Sickle Cell Disease is a chronic disease with acute complications. Emergency Department visits and admissions are less frequent in areas of neonatal screening and comprehensive care. Italy is facing an increase in immigration with an increase in Sickle Cell patients. A neonatal screening programme is lacking and comprehensive care programmes are starting. Health operators are not familiar with this emerging disease. Objectives. To evaluate: rate and pattern of Emergency Department access by Sickle Cell children; accuracy of clinical approach by Emergency Department personnel; factors associated with admission. Methods. A retrospective analysis of Paediatric Emergency Department clinical records of Sickle Cell children from 1999 to 2006. Results. Overall 69 were Emergency Department visits for 14 children. Mean visits/child were 5 (range: 1-8). Mean age at first visit was 34 months (range: 1-194). All were immigrants (93% African). 60% had first diagnosis of Sickle Cell in the Emergency Department. Main reasons of access were fever (64%) and pain (40%). Only 5/69 visits had information on vaccinations, 17/69 on antibiotic prophylaxis, 4/69 on folic acid. Rate of admission was 61%, mean length of stay was 4.7 days. Main diagnosis at discharge was: vaso-occlusive crisis (29%), respiratory infection (25%), haemolysis (20%). Factors associated with admission were (p < 0.05): fever, pain, older age, high C-reactive protein. Conclusions. The Emergency Department is a frequent site of first diagnosis of Sickle Cell Disease; age at diagnosis and rate of admission are high. Approach to the disease by Health personnel can be improved.