title: Vaso-occlusive episodes in older children with sickle cell disease: emergency department management and pain assessment.
abstract: OBJECTIVE
  To describe emergency department (ED) management of older children with sickle cell disease (SCD) experiencing a vaso-occlusive episode (VOE) and factors associated with disposition and ED return.
  
  
  METHODS
  We retrospectively reviewed ED visits of children age >/=8 years with SCD over the course of 1 year. Data were collected from the electronic medical record and the SCD database.
  
  
  RESULTS
  VOE was diagnosed 279 times in 105 patients; 45 of the patients had 1 ED visit, 25 had 2 ED visits, and 16 had >/=5 ED visits. The overall admission rate was 178/279 (64%), 166 on the first ED visit and 12 on a return visit within 72 hours. Use of home opioids, duration of VOE, and hemoglobin concentration were not associated with disposition. Discharge after 2 doses of intravenous (IV) morphine occurred in 33 patients. Pain relief after 1 dose, using a FACES scale of 1 to 5, differed significantly between the admitted patients and the discharged patients (1.1 vs 2.5; P < .0001).
  
  
  CONCLUSIONS
  Suboptimal pain relief after 1 dose of IV morphine was associated with admission from the ED. Further investigation of pain relief, using validated pain assessment scales, as an outcome in VOE management is warranted.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Children's Medical Center, Dallas, TX, USA.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Frei-Jones
authors.forename: Amy L
authors.initials: AL
authors.lastname: Baxter
authors.forename: Zora R
authors.initials: ZR
authors.lastname: Rogers
authors.forename: George R
authors.initials: GR
authors.lastname: Buchanan
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D001794:Blood Pressure / Q000502:physiology*; D001808:Blood Vessels / Q000503:physiopathology; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications* / Q000175:diagnosis