Treatment of uncomplicated vaso-occlusive crises in children with sickle cell disease in a day hospital.
BACKGROUND
Day hospital management for patients with sickle cell disease experiencing uncomplicated vaso-occlusive pain crises has been described in adult populations as an alternative care delivery system. The objective of this study was to characterize and descriptively assess the benefits of a day hospital exclusively designed for children.


METHODS
We retrospectively studied all admissions to the Day Hospital at the Texas Children's Sickle Cell Center since its inception in 2000. A Day Hospital admission was defined as a minimum of two consecutive days of aggressive pain management as an outpatient, including intravenous hydration and analgesics, supported by home treatment over night with oral analgesic and anti-inflammatory agents. We gathered data on demographics, incoming pain score, provider type, opioid administration, length of stay, and needs for higher level care.


RESULTS
A total of 35 patients, ages 2-19, accounted for 80 episodes during the study period. The median incoming pain score was 8 on a scale from 1 to 10. The median length of stay was 2 days. The return rate for acute care within 48 hr for persistent symptoms was 7%. Seventy-one percent of patients admitted to the Day Hospital were treated without requiring transfer to inpatient care for escalating pain or medical needs.


CONCLUSIONS
We conclude that a dedicated Day Hospital facility has the potential to provide patient-centered, effective, and timely management of vaso-occlusive crises in children as well as adults.
Raphael
Jean L
JL
Baylor College of Medicine, Pediatrics, Texas Children's Cancer Center, Houston, Texas, USA. raphael@bcm.edu
Kamdar
Aditi
A
Beavers
M Brooke
MB
Mahoney
Donald H
DH
Mueller
Brigitta U
BU
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003631:Day Care, Medical; D006760:Hospitalization; D006801:Humans; D010045:Outpatients; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement; D011787:Quality of Health Care; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000188:drug therapy* / Q000209:etiology