Emergency department management of acute pain episodes in sickle cell disease. Acad Emerg Med 2007 May;14(5):419-25
Date
03/29/2007Pubmed ID
17389246DOI
10.1197/j.aem.2006.11.033Scopus ID
2-s2.0-34247156073 (requires institutional sign-in at Scopus site) 99 CitationsAbstract
OBJECTIVES: To characterize the initial management of patients with sickle cell disease and an acute pain episode, to compare these practices with the American Pain Society Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in the emergency department, and to identify factors associated with a delay in receiving an initial analgesic.
METHODS: This was a multicenter retrospective design. Consecutive patients with an emergency department visit in 2004 for an acute pain episode related to sickle cell disease were included. Exclusion criteria included age younger than 18 years. A structured medical record review was used to abstract data, including the following outcome variables: analgesic agent and dose, route, and time to administration of initial analgesic. Additional variables included demographics, triage level, intravenous access, and study site. Mann-Whitney U test or Kruskal-Wallis test and multivariate regression were used to identify differences in time to receiving an initial analgesic between groups.
RESULTS: There were 612 patient visits, with 159 unique patients. Median time to administration of an initial analgesic was 90 minutes (25th to 75th interquartile range, 54-159 minutes). During 87% of visits, patients received the recommended agent (morphine or hydromorphone); 92% received the recommended dose, and 55% received the drug by the recommended route (intravenously or subcutaneously). Longer times to administration occurred in female patients (mean difference, 21 minutes; 95% confidence interval = 7 to 36 minutes; p = 0.003) and patients assigned triage level 3, 4, or 5 versus 1 or 2 (mean difference, 45 minutes; 95% confidence interval = 29 to 61 minutes; p = 0.00). Patients from study sites 1 and 2 also experienced longer delays.
CONCLUSIONS: Patients with an acute painful episode related to sickle cell disease experienced significant delays to administration of an initial analgesic.
Author List
Tanabe P, Myers R, Zosel A, Brice J, Ansari AH, Evans J, Martinovich Z, Todd KH, Paice JAAuthor
Amy Elizabeth Zosel MD Associate Professor in the Emergency Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute DiseaseAdolescent
Adult
Aged
Analgesics
Anemia, Sickle Cell
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Pain
Pain Measurement
Regression Analysis
Retrospective Studies
Statistics, Nonparametric
United States
