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Treatment of uncomplicated vaso‐occlusive crises in children with sickle cell disease in a day hospital
Author(s) -
Raphael Jean L.,
Kamdar Aditi,
Beavers M. Brooke,
Mahoney Donald H.,
Mueller Brigitta U.
Publication year - 2008
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21483
Subject(s) - medicine , vaso occlusive crisis , pediatrics , emergency medicine , disease , sickle cell anemia , analgesic , pain management , physical therapy , anesthesia
Background Day hospital management for patients with sickle cell disease experiencing uncomplicated vaso‐occlusive pain crises has been described in adult populations as an alternative care delivery system. The objective of this study was to characterize and descriptively assess the benefits of a day hospital exclusively designed for children. Procedure We retrospectively studied all admissions to the Day Hospital at the Texas Children's Sickle Cell Center since its inception in 2000. A Day Hospital admission was defined as a minimum of two consecutive days of aggressive pain management as an outpatient, including intravenous hydration and analgesics, supported by home treatment over night with oral analgesic and anti‐inflammatory agents. We gathered data on demographics, incoming pain score, provider type, opioid administration, length of stay, and needs for higher level care. Results A total of 35 patients, ages 2–19, accounted for 80 episodes during the study period. The median incoming pain score was 8 on a scale from 1 to 10. The median length of stay was 2 days. The return rate for acute care within 48 hr for persistent symptoms was 7%. Seventy‐one percent of patients admitted to the Day Hospital were treated without requiring transfer to inpatient care for escalating pain or medical needs. Conclusions We conclude that a dedicated Day Hospital facility has the potential to provide patient‐centered, effective, and timely management of vaso‐occlusive crises in children as well as adults. Pediatr Blood Cancer 2008;51:82–85. © 2008 Wiley‐Liss, Inc.