title: The management of sickle cell pain in the emergency department: a priority for health systems.
abstract: OBJECTIVE
  Pain is the most common reason for admission to the Emergency Department (ED) in patients with sickle cell disease (SCD). It can be associated with severe complications and impairs quality of life. Pain management in the ED should be well-defined and aggressive. The objective of this study was to evaluate pain management in the pediatric ED of a country recently facing SCD and to identify priority areas of intervention.
  
  
  METHODS
  The charts of SCD children who had accessed the ED from January 2003 to December 2010 were retrospectively reviewed. Pain management was compared before and after 2008. During 2008, educational events on SCD-pain management involved the ED personnel.
  
  
  RESULTS
  Twenty-three/28 patients (82%) accessed the ED for/with pain, of a total of 96/185 accesses for/with pain. Mean age was 5.9 years (range, 8 mo to 17.9 y). Fifty-four percent of the episodes resulted in hospital admissions, with a mean length of stay of 6.2 days. Pain was scored in 30% of the episodes; analgesics were administered in 50%. After the educational interventions, high score at triage was assigned more frequently (72% vs. 40%), waiting time for analgesics administration reduced (64 vs. 87 min), and use of Visual Analogue Scale increased (50% vs. 8%).
  
  
  CONCLUSIONS
  Pain represents the main reason for admission to the ED in children with SCD even in countries recently facing SCD. Educational interventions obtained significant but still limited improvement in pain management. The diffusion of national guidelines with defined pain evaluation and treatment protocols represents a priority to further ameliorate care of SCD children.
authors: Department of Pediatrics, Pediatric Pain and Palliative Care Service, Azienda Ospedaliera-University of Padova, Padova, Italy.
authors: Chiara
authors: C
authors: Po'
authors: Raffaella
authors: R
authors: Colombatti
authors: Amelia
authors: A
authors: Cirigliano
authors: Liviana
authors: L
authors: Da Dalt
authors: Caterina
authors: C
authors: Agosto
authors: Franca
authors: F
authors: Benini
authors: Stefania
authors: S
authors: Zanconato
authors: Laura
authors: L
authors: Sainati
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004502:Education, Medical, Continuing / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education* / Q000706:statistics & numerical data*; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology*; D059408:Pain Management / Q000379:methods / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome