Time to pain relief: A randomized controlled trial in the emergency department during vaso‐occlusive episodes in sickle cell disease

• Published in: European journal of haematology Vol. 110; no. 5; pp. 518 - 526
• Main Authors: Tanabe, Paula, Bosworth, Hayden B., Crawford, Regina D., Glassberg, Jeffrey, Miller, Christopher N., Paice, Judith A., Silva, Susan
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2023
• Subjects: Adult; Anemia, Sickle Cell - complications; Anemia, Sickle Cell - diagnosis; Anemia, Sickle Cell - therapy; Clinical trials; emergency; Emergency medical care; Emergency Service, Hospital; Humans; Pain; Pain - diagnosis; Pain - etiology; Pain Management - methods; sickle cell; Sickle cell disease; vaso‐occlusive episodes; emergency; pain; vaso-occlusive episodes; sickle cell
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.13924

Objective Compare time to pain relief (minimum of a 13 mm and 30% reduction) during an Emergency Department (ED) visit among patients with sickle cell disease (SCD) experiencing severe pain associated with a vaso‐occlusive episode who were randomized to receive either an individualized or weight‐based pain protocol. Methods A randomized controlled trial in two EDs. Adults with sickle cell disease. Research staff recorded pain scores every 30 min during an ED visit (up to 6 h in the ED) using a 0–100 mm visual analogue scale. Analysis included 122 visits, representing 49 patients (individualized: 61 visits, 25 patients; standard: 61 visits, 24 patients). Results Pain reduction across 6‐h was greater for the individualized compared to the standard protocol (protocol‐by‐time: p = .02; 6‐h adjusted pain score comparison: Individualized: M = 29.2, SD = 38.8, standard: M = 45.3, SD = 35.6; p = .03, Cohen d = 0.43). Hazards models indicated a greater probability of 13 mm (HR = 1.54, 95% CI = 1.05, 2.27, p = .03) and 30% (HR = 1.71, 95% CI = 1.11, 2.63, p = .01) reduction in the individualized relative to the standard protocol. Conclusions Patients who received treatment with an individualized protocol experienced a more rapid reduction in pain, including a 13 mm and 30% reduction in pain scores when compared to those that received weight‐based dosing.