Pain management trend of vaso-occulsive crisis (VOC) at a community hospital emergency department (ED) for patients with sickle cell disease

详细信息    查看全文

• 作者：Susumu Inoue ; Isra'a Khan ; Rao Mushtaq ; Srinivasa Reddy Sanikommu…
• 关键词：Pain management ; Sickle cell disease ; Quality of care ; Emergency department
• 刊名：Annals of Hematology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：95
• 期：2
• 页码：221-225
• 全文大小：298 KB
• 参考文献：1.Benjamin LJ, Dampier CD, Jacox AK, et al. (1999) Guideline for the management of acute and chronic pain in sickle-cell disease. APS Clinical Practice Guideline Series, No. 1, Glenville,IL.
  2.Solomon LR (2010) Pain management in adults with sickle cell disease in a medical center emergency department. J Natl Med Assoc 102:1025–1032PubMed CrossRef
  3.Zempsky WT, Loiselle KA, McKay K, Lee BH, Hagstrom JN, Schechter N (2010) Do children with sickle cell disease receive disparate care for pain in the emergency department? J Emerg Med 39:691–695PubMed CrossRef
  4.Tanabe P, Artz N, Mark Courtney D, Martinovich Z, Weiss KB, Zvirbulis E, Hafner JW (2010) Adult emergency department patients with sickle cell pain crisis: a learning collaborative model to improve analgesic management. Acad Emerg Med 17:399–407PubMed CrossRef
  5.Lazio MP, Costello HH, Courtney DM, Martinovich Z, Myers R, Zosel A, Tanabe P (2010) A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic. Clin J Pain 26:199–205PubMed PubMedCentral CrossRef
  6.Morrissey LK, Shea JO, Kalish LA, Weiner DL, Branowicki P, Heeney MM (2009) Clinical practice guideline improves the treatment of sickle cell disease vaso-occulsive pain. Pediatr Blood Cancer 52(3):369–372PubMed CrossRef
  7.Tanabe P, Myers R, Zosel A, Brice J, Ansari AH, Evans J, Martinovich Z, Todd KH, Paice JA (2007) Emergency department management of acute pain episodes in sickle cell disease. Acad Emerg Med 14:419–425PubMed CrossRef
  8.Ender KL, Krajewski JA, Babineau J, Tresgallo M, Schechter W, Saroyan JM, Kharbanda A (2014) Use of a clinical pathway to improve the acute management of vaso-occlusive crisis pain in pediatric sickle cell disease. Pediatr Blood Cancer 61:693–696PubMed CrossRef
  9.Shenoi R, Ma L, Syblik D, Yusuf S (2011) Emergency department crowding and analgesic delay in pediatric sickle cell pain crises. Pediatr Emerg Care 27:911–917PubMed CrossRef
  10.Murphy A, O’Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Hom J, Kandamany N (2014) Intranasal fentanyl for the management of acute pain in children. Cochrane Database Syst Rev 10:CD009942. doi:10.​1002/​14651858 PubMed
  11.Barrett MJ, Cronin J, Murphy A, McCoy S, Hayden J, An Fhailí S, Grant T, Wakai A, McMahon C, Walsh S, O’Sullivan R (2012) Intranasal fentanyl versus intravenous morphine in the emergency department treatment of severe painful sickle cell crises in children: study protocol for a randomised controlled trial. Trials 13:74. doi:10.​1186/​1745-6215-13-74 PubMed PubMedCentral CrossRef
  12.Fillingim RB, King CD, Ribeiro-Dasilva MC et al (2009) Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 10:447–485PubMed PubMedCentral CrossRef
  13.Mogil JS (2012) Sex differences in pain and pain inhibition: multiple explanations of a controversial phenomenon. Nat Rev Neurosci 13:859–866PubMed CrossRef
  14.Paller CJ, Campbell CM, Edwards RR et al (2009) Sex based differences in pain perception and treatment. Pain Med 10:289–299PubMed PubMedCentral CrossRef
  15.Redding-Lallinger R, Knoll C (2006) Sickle cell disease—pathophysiology and treatment. Curr Probl Pediatr Adolesc Health Care 36:346–376PubMed CrossRef
  
• 作者单位：Susumu Inoue (1)
  Isra’a Khan (2)
  Rao Mushtaq (3)
  Srinivasa Reddy Sanikommu (4)
  Carline Mbeumo (5)
  Jenny LaChance (6)
  Michael Roebuck (7)
  
  1. Department of Pediatric Hematology/Oncology, Hurley Children’s Hospital, Flint, MI, 48503, USA
  2. Community Hospital North, Community Health Network, Indianapolis, IN, USA
  3. Wake Forest Baptist Medical Center, Wake Forest University, Winston Salem, NC, USA
  4. Cleveland Clinic Cancer Center, Cleveland, OH, USA
  5. Department of Pediatrics, Hurley Children’s Hospital, Flint, MI, 48503, USA
  6. Department of Research, Hurley Medical Center, Flint, MI, 48503, USA
  7. Department of Emergency Medicine, Hurley Medical Center, Flint, MI, 48503, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Hematology
  Oncology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-0584

文摘

Pain management at the emergency department (ED) for vaso-occulsive crisis (VOC) for patients with sickle cell disease has not been optimum, with a long delay in giving the initial analgesic. We conducted a retrospective survey over a 7-year period to determine our ED’s timing in giving pain medication to patients with VOC as a quality improvement project. We compared different periods, children vs adults, and the influence of gender in the analgesic administration timing. This is a retrospective chart review of three different periods: (1) years 2007–2008, (2) years 2011–2012, and (3) year 2013. We extracted relevant information from ED records. Data were analyzed using Student t test, chi-square analysis, and the Kruskal-Wallis test. There was a progressive improvement in the time interval to the 1st analgesic over these three periods. Children received analgesics more quickly than adults in all periods. Male adult patients received pain medication faster than female adult patients, although initial pain scores were higher in female than in male patients. Progressively fewer pediatric patients utilized ED over these three periods, but no difference for adult patients was observed. The proportion of pediatric patients admitted to the hospital increased with each period. The progressive decrease in both the number of patients and the number of visits to the ED by children suggested that the collective number of VOC in children has decreased, possibly secondary to the dissemination of hydroxyurea use. We failed to observe the same trend in adult patients. The need for IV access, and ordering laboratory tests or imaging studies tends to delay analgesic administration. Delay in administration of the first analgesic was more pronounced for female adult patients than male adult patients in spite of their higher pain score. Health care providers working in ED should make conscious efforts to respect pain in women as well as pain in men. Though not proven from this study, we believe that a significantly wider use of hydroxyurea by adult patients most likely would reduce their utilization of ED for the purpose of relief of pain, and further pediatric hematologists may be better positioned to increase hydroxyurea adherence by young adult patients, since they have had established rapport with them before transitioning to adult care.