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Patient Controlled Analgesia for Adults with Sickle Cell Disease Awaiting Admission from the Emergency Department


Affiliations
1 New England Sickle Cell Institute, Division of Hematology-Oncology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, United States
2 Connecticut Institute for Clinical and Translational Science, 263 Farmington Avenue, Farmington, CT 06030, United States
 

Background: A treatment algorithm for sickle cell disease (SCD) pain in adults presenting to a single emergency department (ED) was developed prioritizing initiation of patient controlled analgesia (PCA) for patients awaiting hospitalization. Objectives: Evaluate the proportion of ED visits in which PCA was started in the ED. Methods: A two-year retrospective chart reviewof consecutive SCD pain ED visits was undertaken. Data abstracted included PCA initiation, low versus high utilizer status, pain scores, bolus opioid number, treatment times, and length of hospitalization. Results: 258 visits resulted in hospitalization. PCA was initiated in 230 (89%) visits of which 157 (68%) were initiated in the ED. Time to PCA initiation was longer when PCA was begun after hospitalization versus in the ED(8.6 versus 4.5 hours, P < 0.001). ED PCA initiation was associated with fewer opioid boluses following decision to admit and less time without analgesic treatment (all P <0.05). Mean pain intensity (MPI) reduction did not differ between groups. Among visits where PCA was begun in the ED, low utilizers demonstrated greater MPI reduction than high utilizers (2.8 versus 2.0, P = 0.04). Conclusions: EDPCA initiation for SCD-related pain is possible and associatedwithmore timely analgesic delivery.
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  • Patient Controlled Analgesia for Adults with Sickle Cell Disease Awaiting Admission from the Emergency Department

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Authors

Josue Santos
New England Sickle Cell Institute, Division of Hematology-Oncology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, United States
Sasia Jones
New England Sickle Cell Institute, Division of Hematology-Oncology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, United States
Daniel Wakefield
Connecticut Institute for Clinical and Translational Science, 263 Farmington Avenue, Farmington, CT 06030, United States
James Grady
Connecticut Institute for Clinical and Translational Science, 263 Farmington Avenue, Farmington, CT 06030, United States
Biree Andemariam
New England Sickle Cell Institute, Division of Hematology-Oncology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, United States

Abstract


Background: A treatment algorithm for sickle cell disease (SCD) pain in adults presenting to a single emergency department (ED) was developed prioritizing initiation of patient controlled analgesia (PCA) for patients awaiting hospitalization. Objectives: Evaluate the proportion of ED visits in which PCA was started in the ED. Methods: A two-year retrospective chart reviewof consecutive SCD pain ED visits was undertaken. Data abstracted included PCA initiation, low versus high utilizer status, pain scores, bolus opioid number, treatment times, and length of hospitalization. Results: 258 visits resulted in hospitalization. PCA was initiated in 230 (89%) visits of which 157 (68%) were initiated in the ED. Time to PCA initiation was longer when PCA was begun after hospitalization versus in the ED(8.6 versus 4.5 hours, P < 0.001). ED PCA initiation was associated with fewer opioid boluses following decision to admit and less time without analgesic treatment (all P <0.05). Mean pain intensity (MPI) reduction did not differ between groups. Among visits where PCA was begun in the ED, low utilizers demonstrated greater MPI reduction than high utilizers (2.8 versus 2.0, P = 0.04). Conclusions: EDPCA initiation for SCD-related pain is possible and associatedwithmore timely analgesic delivery.