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

• Type of Material: Article
• Authors: Scott T. Miller, SUNY Downstate; Hae-Young Kim, New England Research Institutes; Debra Weiner, Children's Hospital Boston; Carrie G. Wager, New England Research Institutes; Dianne Gallagher, New England Research Institutes; Lori Styles, Children's Hospital & Research Center at Oakland; Carlton Dampier, Emory University; Investigators of the Sickle Cell Disease Clinical Research Network (SCDCRN)
• Language: English
• Date: 2012-03-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/ajh.22265
• Title of Journal or Parent Work: American Journal of Hematology
• ISSN: 0361-8609
• Volume: 87
• Issue: 3
• Start Page: 333
• End Page: 336
• Grant/Funding Information: This publication was made possible by Grant Number U10HL083721 from the National Heart, Lung, and Blood Institute, National Institutes of Health.
• Keywords: Hematology; fluid management; opioid; acute chest syndrome; hydoxyurea; PROACTIVE; spirometry; vaso-occlusion; Life Sciences & Biomedicine; Science & Technology; occlusion
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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.