Sickle cell screening practice in pediatric emergency departments.

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Management of black children who present to a pediatric emergency department (ED) commonly requires knowledge of their sickle cell status. To determine the practice of sickle cell screening, 32 pediatric EDs were surveyed. Twenty-eight (88%) completed the survey, and, of these, 22 (79%) included sickle cell screening (differential solubility test for hemoglobin S) in the management of a black febrile six-month-old infant. To determine the method of screening for sickle cell disease, 60 consecutive black children less than two years of age, who presented to a pediatric ED, were reviewed prospectively. In 51 patients (85%), their condition warranted knowledge of their sickle cell status. Of these, parents of only nine (18%) children knew their child's sickle cell status. Thirty-five (69%) patients had a presumptive newborn screening test for sickle cell disease, but only 15 presented between 8 AM and 5 PM on a weekday, the time during which the newborn screening laboratory could be telephoned for test results. For these same 15 patients, 13 had private physicians, but only three physicians had results of newborn sickle cell screening tests. The patients' hospital records were reviewed, and nine (18%) patients had prior sickle cell screening tests, but five of these tests were performed before the child was six months of age. To determine sickle cell status, 30 (59%) patients required a sickle cell screening test in the ED. ED screening detected three (6%) newly diagnosed sickle cell trait patients. In summary, sickle cell screening is recommended for young black children who present to an ED with fever or signs and symptoms supportive of sickle cell disease complications.(ABSTRACT TRUNCATED AT 250 WORDS)