Emergency Department Management of Acute Pain Episodes in Sickle Cell Disease

Paula Tanabe*, Randall Myers, Amy Zosel, Jane Brice, Altaf H. Ansari, Julia Evans, Zoran Martinovich, Knox H. Todd, Judith A. Paice

*Corresponding author for this work

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Objectives: To characterize the initial management of patients with sickle cell disease and an acute pain episode, to compare these practices with the American Pain Society Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in the emergency department, and to identify factors associated with a delay in receiving an initial analgesic. Methods: This was a multicenter retrospective design. Consecutive patients with an emergency department visit in 2004 for an acute pain episode related to sickle cell disease were included. Exclusion criteria included age younger than 18 years. A structured medical record review was used to abstract data, including the following outcome variables: analgesic agent and dose, route, and time to administration of initial analgesic. Additional variables included demographics, triage level, intravenous access, and study site. Mann-Whitney U test or Kruskal-Wallis test and multivariate regression were used to identify differences in time to receiving an initial analgesic between groups. Results: There were 612 patient visits, with 159 unique patients. Median time to administration of an initial analgesic was 90 minutes (25th to 75th interquartile range, 54-159 minutes). During 87% of visits, patients received the recommended agent (morphine or hydromorphone); 92% received the recommended dose, and 55% received the drug by the recommended route (intravenously or subcutaneously). Longer times to administration occurred in female patients (mean difference, 21 minutes; 95% confidence interval = 7 to 36 minutes; p = 0.003) and patients assigned triage level 3, 4, or 5 versus 1 or 2 (mean difference, 45 minutes; 95% confidence interval = 29 to 61 minutes; p = 0.00). Patients from study sites 1 and 2 also experienced longer delays. Conclusions: Patients with an acute painful episode related to sickle cell disease experienced significant delays to administration of an initial analgesic.

Original languageEnglish (US)
Pages (from-to)419-425
Number of pages7
JournalAcademic Emergency Medicine
Volume14
Issue number5
DOIs
StatePublished - May 1 2007

Fingerprint

Acute Pain
Sickle Cell Anemia
Hospital Emergency Service
Analgesics
Triage
Hydromorphone
Confidence Intervals
Nonparametric Statistics
Practice Guidelines
Chronic Pain
Morphine
Medical Records
Demography

Keywords

  • American Pain Society
  • analgesic use
  • emergency department
  • guideline
  • pain
  • sickle cell disease

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Tanabe, Paula ; Myers, Randall ; Zosel, Amy ; Brice, Jane ; Ansari, Altaf H. ; Evans, Julia ; Martinovich, Zoran ; Todd, Knox H. ; Paice, Judith A. / Emergency Department Management of Acute Pain Episodes in Sickle Cell Disease. In: Academic Emergency Medicine. 2007 ; Vol. 14, No. 5. pp. 419-425.
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title = "Emergency Department Management of Acute Pain Episodes in Sickle Cell Disease",
abstract = "Objectives: To characterize the initial management of patients with sickle cell disease and an acute pain episode, to compare these practices with the American Pain Society Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in the emergency department, and to identify factors associated with a delay in receiving an initial analgesic. Methods: This was a multicenter retrospective design. Consecutive patients with an emergency department visit in 2004 for an acute pain episode related to sickle cell disease were included. Exclusion criteria included age younger than 18 years. A structured medical record review was used to abstract data, including the following outcome variables: analgesic agent and dose, route, and time to administration of initial analgesic. Additional variables included demographics, triage level, intravenous access, and study site. Mann-Whitney U test or Kruskal-Wallis test and multivariate regression were used to identify differences in time to receiving an initial analgesic between groups. Results: There were 612 patient visits, with 159 unique patients. Median time to administration of an initial analgesic was 90 minutes (25th to 75th interquartile range, 54-159 minutes). During 87{\%} of visits, patients received the recommended agent (morphine or hydromorphone); 92{\%} received the recommended dose, and 55{\%} received the drug by the recommended route (intravenously or subcutaneously). Longer times to administration occurred in female patients (mean difference, 21 minutes; 95{\%} confidence interval = 7 to 36 minutes; p = 0.003) and patients assigned triage level 3, 4, or 5 versus 1 or 2 (mean difference, 45 minutes; 95{\%} confidence interval = 29 to 61 minutes; p = 0.00). Patients from study sites 1 and 2 also experienced longer delays. Conclusions: Patients with an acute painful episode related to sickle cell disease experienced significant delays to administration of an initial analgesic.",
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Emergency Department Management of Acute Pain Episodes in Sickle Cell Disease. / Tanabe, Paula; Myers, Randall; Zosel, Amy; Brice, Jane; Ansari, Altaf H.; Evans, Julia; Martinovich, Zoran; Todd, Knox H.; Paice, Judith A.

In: Academic Emergency Medicine, Vol. 14, No. 5, 01.05.2007, p. 419-425.

Research output: Contribution to journalArticle

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AU - Myers, Randall

AU - Zosel, Amy

AU - Brice, Jane

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AB - Objectives: To characterize the initial management of patients with sickle cell disease and an acute pain episode, to compare these practices with the American Pain Society Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in the emergency department, and to identify factors associated with a delay in receiving an initial analgesic. Methods: This was a multicenter retrospective design. Consecutive patients with an emergency department visit in 2004 for an acute pain episode related to sickle cell disease were included. Exclusion criteria included age younger than 18 years. A structured medical record review was used to abstract data, including the following outcome variables: analgesic agent and dose, route, and time to administration of initial analgesic. Additional variables included demographics, triage level, intravenous access, and study site. Mann-Whitney U test or Kruskal-Wallis test and multivariate regression were used to identify differences in time to receiving an initial analgesic between groups. Results: There were 612 patient visits, with 159 unique patients. Median time to administration of an initial analgesic was 90 minutes (25th to 75th interquartile range, 54-159 minutes). During 87% of visits, patients received the recommended agent (morphine or hydromorphone); 92% received the recommended dose, and 55% received the drug by the recommended route (intravenously or subcutaneously). Longer times to administration occurred in female patients (mean difference, 21 minutes; 95% confidence interval = 7 to 36 minutes; p = 0.003) and patients assigned triage level 3, 4, or 5 versus 1 or 2 (mean difference, 45 minutes; 95% confidence interval = 29 to 61 minutes; p = 0.00). Patients from study sites 1 and 2 also experienced longer delays. Conclusions: Patients with an acute painful episode related to sickle cell disease experienced significant delays to administration of an initial analgesic.

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