1
|
Nasrollahi FS, Gutierrez DJ, Nocek J, Folami J, Ekram S, Eilbert W, Colla JS. Measurement of left atrial size as a predictor of severity of illness in sickle cell disease. Am J Emerg Med 2024; 83:126-128. [PMID: 39029279 DOI: 10.1016/j.ajem.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/21/2024] [Accepted: 07/02/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is characterized by microvascular occlusion which leads to multiorgan damage, including left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction has been shown to be an independent risk factor for death in SCD patients. Left atrial dilation (LAD) has been used as a surrogate marker for identification of left ventricular diastolic dysfunction. OBJECTIVE Investigate the association of LAD, as determined by echocardiography, with increased disease burden in SCD as reflected by increased emergency department (ED) utilization, increased hemolysis markers, and worsening anemia. METHODS A retrospective cohort study of patients from a single university hospital were selected from a national registry. Age, sickle cell phenotype, echocardiogram findings, ED utilization, baseline hemoglobin, and lab values needed for calculation of hemolytic index were recorded for each patient. Patients were then stratified into two distinct groups based on the presence or absence of LAD to compare ED utilization, baseline hemoglobin and hemolytic index between the two groups. RESULTS 129 patients met the criteria for inclusion with 88 having normal left atrial volume and 41 with LAD. There was a higher percentage of high ED utilizers in the LAD group compared to the normal left atrial volume group [34% vs. 17%, p = 0.03]. Average hemoglobin was lower in the LAD group compared with the normal left atrial volume group [mean 8.57 g/dL vs. 9.47 g/dL, p = 0.011]. The mean hemolytic index was higher in the LAD group when compared with the normal left atrial volume group [0.44 vs. -0.21, p < 0.001]. CONCLUSIONS LAD was associated with higher ED utilization, lower hemoglobin level, and more hemolysis in patients with SCD.
Collapse
Affiliation(s)
| | | | - Judith Nocek
- University of Illinois, Department of Medicine, Sickle Cell Center, Chicago, IL, USA
| | - Jennifer Folami
- University of Illinois, College of Medicine, Rockford, IL, USA
| | - Sahrish Ekram
- University of Illinois, Department of Emergency Medicine, Chicago, IL, USA
| | - Wesley Eilbert
- University of Illinois, Department of Emergency Medicine, Chicago, IL, USA
| | - Joseph S Colla
- University of Illinois, Department of Emergency Medicine, Chicago, IL, USA
| |
Collapse
|
2
|
Rech JS, Cohen A, Bartolucci P, Santin A, Chantalat Auger C, Affo L, Le Jeune S, Arlet JB, Boëlle PY, Steichen O. Shift in emergency department utilization by frequent attendees with sickle cell disease during the COVID-19 pandemic: A multicentre cohort study. Br J Haematol 2024; 205:463-472. [PMID: 38960400 DOI: 10.1111/bjh.19556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/14/2024] [Indexed: 07/05/2024]
Abstract
While the coronavirus disease-2019 (COVID-19) might have increased acute episodes in people living with sickle cell disease (SCD), it may also have changed their reliance on emergency department (ED) services. We assessed the impact of the COVID-19 pandemic and lockdowns on ED visits in adult SCD people followed in five French reference centres, with a special focus on 'high users' (≥10 visits in 2019). We analysed the rate of ED visits from 1 January 2015 to 31 December 2021, using a self-controlled case series. Among 1530 people (17 829 ED visits), we observed a significant reduction in ED visits during and after lockdowns, but the effect vanished over time. Compared to pre-pandemic, incidence rate ratios for ED visits were 0.59 [95% CI 0.52-0.67] for the first lockdown, 0.66 [95% CI 0.58-0.75] for the second and 0.85 [95% CI 0.73-0.99] for the third. High users (4% of people but 33.7% of visits) mainly drove the reductions after the first lockdown. COVID-19 lockdowns were associated with reduced ED visits. While most people returned to their baseline utilization by April 2021, high users had a lasting decrease in ED visits. Understanding the factors driving the drop in ED utilization among high users might inform clinical practice and health policy.
Collapse
Affiliation(s)
- J S Rech
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Réseau Sentinelles, Paris, France
- GRC 25, DREPS - Drépanocytose: Groupe de Recherche de Paris - Sorbonne Université, Sorbonne Université, Hôpital Tenon, Paris, France
- AP-HP, Hôpital Tenon, Service de Médecine Interne, Paris, France
- Hôpital Saint-Joseph, Service de Médecine Interne, Marseille, France
| | - A Cohen
- Département Innovation et Données, Direction des Services Numériques, AP-HP, Paris, France
| | - P Bartolucci
- Univ Paris Est Créteil, Hôpitaux Universitaires Henri Mondor, AP-HP, Sickle Cell and Red Cell Disorders Referral Center - UMGGR, Créteil, France
- IMRB, Laboratory of Excellence LABEX GRex, Créteil, France
| | - A Santin
- GRC 25, DREPS - Drépanocytose: Groupe de Recherche de Paris - Sorbonne Université, Sorbonne Université, Hôpital Tenon, Paris, France
- AP-HP, Hôpital Tenon, Service de Médecine Interne, Paris, France
| | - C Chantalat Auger
- AP-HP, Hôpital Bicêtre, Service de Médecine Interne, Le Kremlin-Bicêtre, France
| | - L Affo
- AP-HP, Hôpital Louis Mourier, Service de Médecine Interne, Colombes, France
- Université Paris Cité, Paris, France
| | - S Le Jeune
- AP-HP, Hôpital Avicenne, Service de Médecine Interne, Bobigny, France
- Université Paris Cité, INSERM, Paris Cardiovascular Research Center, PARCC, Paris, France
| | - J B Arlet
- AP-HP, Hôpital Européen Georges Pompidou, Internal Medicine Department, French National Sickle Cell Referral Center, Paris, France
| | - P Y Boëlle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Réseau Sentinelles, Paris, France
| | - O Steichen
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Réseau Sentinelles, Paris, France
- GRC 25, DREPS - Drépanocytose: Groupe de Recherche de Paris - Sorbonne Université, Sorbonne Université, Hôpital Tenon, Paris, France
- AP-HP, Hôpital Tenon, Service de Médecine Interne, Paris, France
| |
Collapse
|
3
|
Attell BK, Barrett PM, Pace BS, McLemore ML, McGee BT, Oshe R, DiGirolamo AM, Cohen LL, Snyder AB. Characteristics of Emergency Department Visits Made by Individuals With Sickle Cell Disease in the U.S., 1999-2020. AJPM FOCUS 2024; 3:100158. [PMID: 38149076 PMCID: PMC10749880 DOI: 10.1016/j.focus.2023.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Introduction Individuals living with sickle cell disease experience high levels of morbidity that result in frequent utilization of the emergency department. The objective of this study was to provide updated national estimates of emergency department utilization associated with sickle cell disease in the U.S. Methods Data from the National Hospital Ambulatory Medical Care Survey for the years 1999-2020 were analyzed. Complex survey analysis was utilized to produce national estimates overall and by patient age groups. Results On average, approximately 222,612 emergency department visits occurred annually among individuals with sickle cell disease, a nearly 13% increase from prior estimates. The annual volume of emergency department visits steadily increased over time, and pain remains the most common patient-cited reason for visiting the emergency department. Patient-reported pain levels for individuals with sickle cell disease were high, with 64% of visits associated with severe pain and 21% associated with moderate pain. Public insurance sources continue to cover most visits, with Medicaid paying for 60% of visits and Medicare paying for 12% of visits. The average time spent in the emergency department increased from previous estimates by about an hour, rising to approximately 6 hours. The average wait time to see a provider was 53 minutes. Conclusions Utilization of the emergency department by individuals living with sickle cell disease remains high, especially for pain. With more than half of patients with sickle cell disease reporting severe pain levels, emergency department staff should be prepared to assess and treat sickle cell disease-related pain following evidence-based guidelines and recommendations. The findings of this study can help improve care in this population.
Collapse
Affiliation(s)
- Brandon K. Attell
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | | | - Betty S. Pace
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Morgan L. McLemore
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Blake T. McGee
- School of Nursing, Georgia State University, Atlanta, Georgia
| | - Rewo Oshe
- Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, Georgia
| | - Ann M. DiGirolamo
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Lindsey L. Cohen
- Department of Psychology, College of Arts & Sciences, Georgia State University, Atlanta, Georgia
| | - Angela B. Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| |
Collapse
|
4
|
Gehling GM, Powell-Roach K, Wilkie DJ, Dungan JR. Single nucleotide polymorphisms and sickle cell disease-related pain: a systematic review. FRONTIERS IN PAIN RESEARCH 2023; 4:1223309. [PMID: 37781219 PMCID: PMC10538969 DOI: 10.3389/fpain.2023.1223309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background Scientists have speculated genetic variants may contribute to an individual's unique pain experience. Although research exists regarding the relationship between single nucleotide polymorphisms and sickle cell disease-related pain, this literature has not been synthesized to help inform future precision health research for sickle cell disease-related pain. Our primary aim of this systematic review was to synthesize the current state of scientific literature regarding single nucleotide polymorphisms and their association with sickle cell disease-related pain. Methods Using the Prisma guidelines, we conducted our search between December 2021-April 2022. We searched PubMed, Web of Science, CINAHL, and Embase databases (1998-2022) and selected all peer-reviewed articles that included reports of associations between single nucleotide polymorphisms and sickle cell disease-related pain outcomes. Results Our search yielded 215 articles, 80 of which were duplicates, and after two reviewers (GG, JD) independently screened the 135 non-duplicate articles, we retained 22 articles that met the study criteria. The synthesis of internationally generated evidence revealed that this scientific area remains predominantly exploratory in nature, with only three studies reporting sufficient power for genetic association. Sampling varied across studies with a range of children to older adults with SCD. All of the included articles (n = 22) examined acute pain, while only nine of those studies also examined chronic pain. Conclusion Currently, the evidence implicating genetic variation contributing to acute and chronic sickle cell disease-related pain is characterized by modestly powered candidate-gene studies using rigorous SCD-pain outcomes. Effect sizes and directions vary across studies and are valuable for informing the design of future studies. Further research is needed to replicate these associations and extend findings with hypothesis-driven research to inform precision health research.
Collapse
Affiliation(s)
- Gina M. Gehling
- College of Nursing, University of Florida, Gainesville, FL, United States
| | - Keesha Powell-Roach
- College of Nursing, Department of Community and Population Health, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Diana J. Wilkie
- College of Nursing, University of Florida, Gainesville, FL, United States
| | - Jennifer R. Dungan
- College of Nursing, University of Florida, Gainesville, FL, United States
| |
Collapse
|
5
|
Jackson A. Improving Sickle Cell Disease Care. Am J Nurs 2023; 123:47-51. [PMID: 37498039 DOI: 10.1097/01.naj.0000947472.45064.d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
ABSTRACT Research into sickle cell disease (SCD), which disproportionately affects historically underserved ethnic and racial groups, lacks funding and resources. The Centers for Disease Control and Prevention's Sickle Cell Data Collection program is a comprehensive data registry that gathers information about disease prevalence, outcomes, and the type of care patients receive, but it's only currently active in 11 states. This article describes nurses' ethical responsibility to participate in policy work and to advocate for funding for this program, as well as the importance of sharing their perspectives on caring for people who have SCD with legislative representatives.
Collapse
Affiliation(s)
- Andrea Jackson
- Andrea Jackson is an evidence-based practice specialist at Texas Children's Hospital in Houston. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise
| |
Collapse
|