Original ContributionsManagement of sickle cell pain crisis in the emergency department at teaching hospitals
Introduction
The painful crises of sickle cell anemia are common (1). Because of the nature of the disease, and sometimes because of limited access to health care, patients with sickle cell pain crisis (SCPC) are often treated not by a hematologist in the office, but rather by the emergency physician in the Emergency Department (ED).
Each emergency physician’s management of SCPC has evolved as the product of personal experiences with this presentation, hypotheses concerning the pathophysiology of pain crisis, and input from the hematology and chronic pain management communities.
Reviews of the literature disagree on whether “traditional” ED management of SCPC includes hydration as a central element 2, 3, 4, whether oral or i.v. hydration is preferable 2, 3, 5, 6, whether antihistamine adjuvants should be used 2, 5, 7, whether supplemental oxygen should be given to all patients 2, 3, 4, 5, 6, 8, 9, and whether screening laboratory and x-rays studies are indicated in all patients 2, 3, 6, 10. Most reviews suggest that meperidine is the most common parenteral analgesic and that it is most commonly given intramuscularly (i.m.), but others suggest that other analgesics are also common and may be preferable 2, 3, 5, 7, 11, 12. There has been little critical scientific study of the components of ED management of SCPC, and the literature that does exist suggests large variability in the current practice.
The purpose of this study is to determine the frequency and variety of various strategies being used in the ED management of sickle cell pain crises. By identifying the prevailing methods of management, we hope to facilitate communication among emergency physicians regarding the sometimes controversial care of these patients.
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Materials and methods
The Institutional Review Board of the Medical College of Pennsylvania approved this study.
Results
The survey was returned by 527 (52.7%) of the sample. Another 22 respondents ultimately completed the survey by telephone interview, for a total response rate of 55%. Respondents most frequently worked in university hospitals (46%) and community teaching hospitals (36%), with the remainder working mostly in other types of teaching hospitals including children’s, county, or military hospitals. Ninety-one percent were board certified in emergency medicine. Forty-five percent of respondents
Discussion
Sickle cell pain crisis is a common presentation in academic emergency departments. The results of this survey identify patterns in the use of several proposed elements of care. Emergency physicians (and other physicians who care for patients with SCPC) can evaluate their own management strategies against these results.
These data also suggest considerable variability in the management of SCPC in academic EDs. The variability in therapy is illustrated by the use of i.m. pain medicines in the
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