Inpatient management of sickle cell pain: A 'snapshot' of current practice

• Published in: American journal of hematology Vol. 87; no. 3; pp. 333 - 336
• Main Authors: Miller, Scott T., Kim, Hae-Young, Weiner, Debra, Wager, Carrie G., Gallagher, Dianne, Styles, Lori, Dampier, Carlton D.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.03.2012; Wiley-Liss; Wiley Subscription Services, Inc
• Subjects: Acute Chest Syndrome - drug therapy; Acute Chest Syndrome - etiology; Acute Chest Syndrome - therapy; Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Anemia, Sickle Cell - complications; Anemia, Sickle Cell - drug therapy; Anemias. Hemoglobinopathies; Biological and medical sciences; Blood Transfusion - utilization; Child; Child, Preschool; Combined Modality Therapy; Diseases of red blood cells; Drug Utilization - statistics & numerical data; Feasibility Studies; Female; Fluid Therapy - utilization; Hematologic and hematopoietic diseases; Hematology; Humans; Hydroxyurea - therapeutic use; Inpatients; Male; Medical sciences; Middle Aged; Narcotics - administration & dosage; Narcotics - therapeutic use; Oxygen Inhalation Therapy; Pain - drug therapy; Pain - etiology; Practice Patterns, Physicians' - statistics & numerical data; Pulmonary Edema - prevention & control; Randomized Controlled Trials as Topic - statistics & numerical data; Retrospective Studies; Spirometry - utilization; Young Adult; Hemoglobinopathy; Hemolytic anemia; Sickle cell anemia; Clinical management; Pain; Hematology; Hemopathy; Hospital; Genetic disease
• ISSN: 0361-8609; 1096-8652; 1096-8652
• DOI: 10.1002/ajh.22265

The Sickle Cell Disease Clinical Research Network (SCDCRN) designed the PROACTIVE Feasibility Study (ClinicalTrials.gov NCT00951808) to determine whether elevated serum levels of secretory phospholipase A2 (sPLA2) during hospitalization for pain would permit preemptive therapy of sickle cell acute chest syndrome (ACS) by blood transfusion. While PROACTIVE was not designed to assess pain management and was terminated early due to inadequate patient accrual, collection of clinical data allowed a "snapshot" of current care by expert providers. Nearly half the patients admitted for pain were taking hydroxyurea; hydroxyurea did not affect length of stay. Providers commonly administered parenteral opioid analgesia, usually morphine or hydromorphone, to adults and children, generally by patient-controlled analgesia (PCA). Adult providers were more likely to prescribe hydromorphone and did so at substantially higher morphine equivalent doses than were given to adults receiving morphine; the latter received doses similar to children who received either medication. All subjects treated with PCA received higher daily doses of opioids than those treated by time-contingent dosing. Physicians often restricted intravenous fluids to less than a maintenance rate and underutilized incentive spirometry, which reduces ACS in patients hospitalized for pain.