A Comparison of Analgesic Management for Emergency Department Patients With Sickle Cell Disease and Renal Colic

Departments of Emergency Medicine parallelDepartment of Emergency Medicine, The Institute for Healthcare Studies daggerFeinberg School of Medicine, Northwestern University, Chicago, IL, USA.
The Clinical journal of pain (Impact Factor: 2.53). 03/2010; 26(3):199-205. DOI: 10.1097/AJP.0b013e3181bed10c
Source: PubMed


To determine whether there is a difference in time to initial analgesic for patients with acute pain from sickle cell disease (SCD) versus renal colic (RC) and to identify factors contributing to variance in time to analgesic.
A retrospective cohort study of the adult emergency department (ED) patients with acute pain from SCD and RC in an urban ED (final ED discharge ICD-9 diagnosis codes were included). A structured medical record review abstracted the demographics, arrival shift, triage level, initial pain score, triage time, and time of initial analgesic dose. Data were compared with Kaplan-Meier plots of time to initial analgesic for both RC and SCD with the log-rank test to test for differences by disease category. A multivariable Cox regression model estimated differences in time to initial analgesic by disease category while controlling for other possible confounders.
Median time to initial analgesic was 80 minutes for patients with SCD (interquartile range, 48 to 145) versus 50 minutes for patients with RC (interquartile range: 30 to 96). Patients with SCD reported a higher pain score on arrival when compared with RC patients and were more frequently assigned a higher triage priority level (P=0.05). Covariates that contributed the most delays to the model were afternoon arrival [hazard ratio (HR): 0.35, P<0.01], low acuity triage level (HR: 0.42, P<0.01), SCD diagnosis (HR: 0.61, P<0.01), and inability to obtain intravenous access (HR: 0.71, P=0.01).
ED patients with SCD experienced longer delays in the administration of the initial analgesic compared with RC patients, despite higher arrival pain scores and triage acuity levels.

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    • "Sickle cell disease (SCD) is a painful, chronic, genetic condition that affects 90,000–100,000 individuals in the U.S.1 and shortens life expectancy to around 40 years.2–5 While there is wide variation in the use patterns of healthcare by SCD patients, particularly of emergency department (ED) care, there is also substantial evidence of generally poor quality of care for SCD patients in the ED.6–8 The Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS, "
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    ABSTRACT: Introduction Patients with sickle cell disease (SCD) often seek care in emergency departments (EDs) for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1) explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA) in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made) for patients with SCD, and 2) report the failures of these care processes in each ED. Methods A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization. Results Many “high risk” failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies. Conclusion FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease.
    The western journal of emergency medicine 07/2014; 15(4):446-58. DOI:10.5811/westjem.2014.4.20489
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    ABSTRACT: Many studies have found gender differences in frequency and intensity of pain. Women often report lower pain thresholds, higher pain ratings, and lower tolerance for pain. People with sickle cell disease (SCD) experience both chronic and acute pain throughout life. To compare adult men and women with SCD in terms of reported pain, crises, healthcare utilization, and opioid usage. Methods: Two hundred twenty-six adults with SCD in Virginia were enrolled in a prospective cohort study of pain and completed daily diaries for 1-6 months. Subjects reported for the previous day their maximum SCD-related pain, distress, and interference (0-9 scale), whether they were in a sickle cell crisis, had unplanned utilization (clinic, emergency room, or hospitalization), or used opioids. Episodes of pain, crisis, or utilization were defined as consecutive days of such. Men and women were compared, using analysis of covariance (ANCOVA), controlling for age, SCD genotype, depression, and education. There were no significant differences between men and women in the percentage of days subjects experienced pain (men 58.6% vs. women 56.5%) or the number of pain episodes/6 months (7.7 vs. 9.6). Mean pain scores were comparable, when subjects were in crisis (5.5 vs. 5.6) or not (2.5 vs. 2.2). Distress and interference results were similar. Men with the SS genotype reported a higher percentage of days with crisis(18.5% vs. 11.6%) and utilization (5.1% vs. 2.7%) than women with the SS genotype. Contrary to many studies of pain, particularly chronic pain, men and women with SCD reported generally similar pain experiences.
    Journal of Women's Health 04/2006; 15(2):146-54. DOI:10.1089/jwh.2006.15.146 · 2.05 Impact Factor
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    Annales Francaises de Medecine d'Urgence 09/2011; 1(5):326-331. DOI:10.1007/s13341-011-0093-5
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