Management of vaso‐occlusive episodes in the day hospital decreases admissions in children with sickle cell disease

• Published in: British journal of haematology Vol. 186; no. 6; pp. 855 - 860
• Main Authors: Karkoska, Kristine, Appiah‐Kubi, Abena, Rocker, Joshua, Stoffels, Guillaume, Aygun, Banu
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.09.2019
• Subjects: analgesia; Chemotherapy; Children; emergency department; Emergency medical services; Hematology; Intravenous administration; Morphine; Narcotics; Opioids; paediatrics; Patient admissions; Sickle cell anemia; Sickle cell disease; Transfusion; vaso‐occlusive episode; paediatrics; vaso-occlusive episode; emergency department; analgesia; sickle cell disease
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.16002

Summary Acute vaso‐occlusive episodes (VOE) are the most common reason for presentation to the Emergency Department (ED) and inpatient admission in people living with sickle cell disease (SCD). The goal of this study was to compare the hospital admission rate for VOE from our centre’s day hospital (Pediatric Ambulatory Chemotherapy and Transfusion Unit; PACT) versus the ED, and to determine which factors influence admission rate. The study included a total of 370 visits involving 140 children with SCD with a mean age of 10·9 ± 5·5 years. The timing from triage to the first analgesic was significantly different between the PACT and the ED (median, 32 vs. 70 min, P < 0·0001). The initial choice of opioid dosage adhered to our centre’s guidelines 84% of the time in the PACT v. 45% in the ED for morphine (P = 0·0003) and 100% in the PACT vs. 43% (P = 0·002) for hydromorphone. The admission rate from the ED (57%) was significantly higher than that of the PACT (29%) even when accounting for differences in baseline variables (P = 0·0001). In conclusion, the odds of being admitted were 3·8 times higher if the patient was treated in the ED. Timely administration and appropriate dosing of intravenous opioids may change this outcome in the future.