title: Emergency department management of acute pain episodes in sickle cell disease.
abstract: OBJECTIVE
  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.
authors: Department of Emergency Medicine, Northwestern University, Chicago, IL, USA. ptanabe2@nmff.org
authors: Paula
authors: P
authors: Tanabe
authors: Randall
authors: R
authors: Myers
authors: Amy
authors: A
authors: Zosel
authors: Jane
authors: J
authors: Brice
authors: Altaf H
authors: AH
authors: Ansari
authors: Julia
authors: J
authors: Evans
authors: Zoran
authors: Z
authors: Martinovich
authors: Knox H
authors: KH
authors: Todd
authors: Judith A
authors: JA
authors: Paice
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D000755:Anemia, Sickle Cell / Q000150:complications*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014481:United States
chemical_list: D000700:Analgesics