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Treatment of Acute Pain in Adults With Sickle Cell Disease in an Infusion Center Versus the Emergency Department : A Multicenter Prospective Cohort Study.
Lanzkron, Sophie; Little, Jane; Wang, Hang; Field, Joshua J; Shows, J Ryan; Haywood, Carlton; Saheed, Mustapha; Proudford, Marc; Robertson, Derek; Kincaid, Adrienne; Burgess, Lorri; Green, Charles; Seufert, Rebecca; Brooks, Jasmine; Piehet, Allie; Griffin, Brandi; Arnold, Nicole; Frymark, Steven; Wallace, Marcus; Abu Al Hamayel, Nebras; Huang, Chiung-Yu; Segal, Jodi B; Varadhan, Ravi.
Affiliation
  • Lanzkron S; Johns Hopkins University School of Medicine, Baltimore, Maryland (S.L., H.W., M.S., R.S., J.B., J.S.).
  • Little J; Case Western Reserve University School of Medicine and University Hospitals, Cleveland, Ohio (J.L., B.G., N.A.).
  • Wang H; Johns Hopkins University School of Medicine, Baltimore, Maryland (S.L., H.W., M.S., R.S., J.B., J.S.).
  • Field JJ; Blood Center of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin (J.J.F., S.F.).
  • Shows JR; Our Lady of the Lake Hospital, Baton Rouge, Louisiana (J.R.S., A.P.).
  • Haywood C; The Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland (C.H.J.).
  • Saheed M; Johns Hopkins University School of Medicine, Baltimore, Maryland (S.L., H.W., M.S., R.S., J.B., J.S.).
  • Proudford M; William E. Proudford Foundation, Baltimore, Maryland (M.P.).
  • Robertson D; Maryland Sickle Cell Disease Association, Columbia, Maryland (D.R.).
  • Kincaid A; Kincaid's Kindred Spirits, Euclid, Ohio (A.K.).
  • Burgess L; Baton Rouge Sickle Cell Disease Association, Baton Rouge, Louisiana (L.B.).
  • Green C; Community Partner, Milwaukee, Wisconsin (C.G.).
  • Seufert R; Johns Hopkins University School of Medicine, Baltimore, Maryland (S.L., H.W., M.S., R.S., J.B., J.S.).
  • Brooks J; Johns Hopkins University School of Medicine, Baltimore, Maryland (S.L., H.W., M.S., R.S., J.B., J.S.).
  • Piehet A; Our Lady of the Lake Hospital, Baton Rouge, Louisiana (J.R.S., A.P.).
  • Griffin B; Case Western Reserve University School of Medicine and University Hospitals, Cleveland, Ohio (J.L., B.G., N.A.).
  • Arnold N; Case Western Reserve University School of Medicine and University Hospitals, Cleveland, Ohio (J.L., B.G., N.A.).
  • Frymark S; Blood Center of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin (J.J.F., S.F.).
  • Wallace M; Louisiana Health Care Connection, Baton Rouge, Louisiana (M.W.).
  • Abu Al Hamayel N; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (N.A.A.).
  • Huang CY; University of California, San Francisco, San Francisco, California (C.H.).
  • Segal JB; Johns Hopkins University School of Medicine, Baltimore, Maryland (S.L., H.W., M.S., R.S., J.B., J.S.).
  • Varadhan R; Oncology Biostatistics and Bioinformatics, Johns Hopkins University, Baltimore, Maryland (R.V.).
Ann Intern Med ; 174(9): 1207-1213, 2021 09.
Article in En | MEDLINE | ID: mdl-34224261
ABSTRACT

BACKGROUND:

Patients with sickle cell disease (SCD) have vaso-occlusive crises (VOCs). Infusion centers (ICs) are alternatives to emergency department (ED) care and may improve patient outcomes.

OBJECTIVE:

To assess whether care in ICs or EDs leads to better outcomes for the treatment of uncomplicated VOCs.

DESIGN:

Prospective cohort. (ClinicalTrials.gov NCT02411396).

SETTING:

4 U.S. sites, with recruitment between April 2015 and December 2016.

PARTICIPANTS:

Adults with SCD living within 60 miles of a study site. MEASUREMENTS Participants were followed for 18 months after enrollment. Outcomes of interest were time to first dose of parenteral pain medication, whether pain reassessment was completed within 30 minutes after the first dose, and patient disposition on discharge from the acute care visit. Treatment effects for ICs versus EDs were estimated using a time-varying propensity score adjustment.

RESULTS:

Researchers enrolled 483 participants; the 269 who had acute care visits on weekdays are included in this report. With inverse probability of treatment-weighted adjustment, the mean time to first dose was 62 minutes in ICs and 132 minutes in EDs; the difference was 70 minutes (95% CI, 54 to 98 minutes; E-value, 2.8). The probability of pain reassessment within 30 minutes of the first dose of parenteral pain medication was 3.8 times greater (CI, 2.63 to 5.64 times greater; E-value, 4.7) in the IC than the ED. The probability that a participant's visit would end in admission to the hospital was smaller by a factor of 4 (0.25 [CI, 0.18 to 0.33]) with treatment in an IC versus an ED.

LIMITATION:

The study was restricted to participants with uncomplicated VOCs.

CONCLUSION:

In adults with SCD having a VOC, treatment in an IC is associated with substantially better outcomes than treatment in an ED. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Emergency Service, Hospital / Acute Pain / Pain Management / Ambulatory Care Facilities / Analgesics / Anemia, Sickle Cell Type of study: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Limits: Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: Ann Intern Med Year: 2021 Document type: Article
Fulltext
Add to My VHL
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Emergency Service, Hospital / Acute Pain / Pain Management / Ambulatory Care Facilities / Analgesics / Anemia, Sickle Cell Type of study: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Limits: Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: Ann Intern Med Year: 2021 Document type: Article