1
|
Telfer P, Anie KA, Kotsiopoulou S, Aiken L, Hibbs S, Burt C, Stuart-Smith S, Lugthart S. The acute pain crisis in sickle cell disease: What can be done to improve outcomes? Blood Rev 2024; 65:101194. [PMID: 38553339 DOI: 10.1016/j.blre.2024.101194] [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: 12/04/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/21/2024]
Abstract
The acute pain crisis (APC) is the commonest complication of sickle cell disease (SCD). Severe episodes may require treatment in hospital with strong opioid analgesic drugs, combined with additional supportive care measures. Guidelines for APC management have been produced over the past two decades gathering evidence from published studies, expert opinion, and patient perspective. Unfortunately, reports from multiple sources indicate that guidelines are often not followed, and that acute care in emergency departments and on acute medical wards is suboptimal. It is important to understand what leads to this breakdown in health care, and to identify evidence-based interventions which could be implemented to improve care. This review focuses on recently published articles as well as information about on-going clinical trials. Aspects of care which could potentially make a difference to patient experience include availability and accessibility of individual care plans agreed between patient and treating specialist, innovative means of delivering initial opioids to reduce time to first analgesia, and availability of a specialist unit away from the ED, where expert care can be delivered in a more compassionate environment. The current evidence of improved outcomes and health economic advantage with these interventions is inadequate, and this is hampering their implementation into health care systems.
Collapse
Affiliation(s)
- Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, UK; Department of Haematology, Royal London Hospital, Bart's Health NHS Trust, London, UK.
| | - Kofi A Anie
- Brent Sickle Cell & Thalassaemia Centre, London North West University Healthcare NHS Trust, London, UK
| | | | - Laura Aiken
- Department of Haematology, Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Stephen Hibbs
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | - Sanne Lugthart
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, UK; Department of Haematology, University Hospitals of Bristol, Bristol, UK
| |
Collapse
|
2
|
Nwora C, Prince EJ, Pugh L, Weaver MS, Pecker LH. How young adults with sickle cell disease define "being a good patient" in the adult healthcare system. Pediatr Blood Cancer 2024; 71:e30786. [PMID: 38053232 PMCID: PMC10841975 DOI: 10.1002/pbc.30786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/21/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Young adulthood brings new challenges for managing sickle cell disease. There are fewer adult specialists, sickle cell disease morbidities accumulate, and mortality increases. Developmental changes in roles and responsibilities also affect management. This study explores how young adults with sickle cell disease experience their role as a patient. METHODS In this mixed-methods study at a sickle cell center, young adult participants completed the Sickle Cell Self Efficacy Survey, the Measures of Sickle Cell Stigma, and the Adult Sickle Cell Quality of Life Measurement Short-Forms. Semi-structured interviews on the patient role were conducted, transcribed, and then analyzed using thematic analysis. RESULTS Twenty-four participants aged 19-25 years defined expectations of being a "good patient." Five definitional themes emerged: health maintenance, emotion regulation, self-advocacy, honest communication, and empathy for clinicians. Participants identified support from families and clinicians are important facilitators of role fulfillment. DISCUSSION How young adult patients with sickle cell disease define being a "good patient" has implications for the transition of care for both pediatric and adult medicine practices. This understanding can inform healthcare system designs and programs aimed at supporting patients and families.
Collapse
Affiliation(s)
- Christle Nwora
- Department of Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth J. Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura Pugh
- Internal Medicine Resident, University of California San Francisco, San Francisco, CA
| | - Meaghann S. Weaver
- National Center for Ethics in Healthcare, Veteran Affairs, Washington DC
| | - Lydia H. Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
3
|
Coleman KD, McKinley K, Ellison AM, Alpern ER, Hariharan S, Topoz I, Wurtz M, MStat BN, Cook LJ, Morris CR, Brandow AM, Campbell AD, Liem RI, Nuss R, Quinn CT, Thompson AA, Villella A, King AA, Baumann A, Frankenberger W, Brousseau DC. Return visit rates after an emergency department discharge for children with sickle cell pain episodes. Pediatr Blood Cancer 2023; 70:e30553. [PMID: 37458568 PMCID: PMC11078470 DOI: 10.1002/pbc.30553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND High return visit rates after hospitalization for people with sickle cell disease (SCD) have been previously established. Due to a lack of multicenter emergency department (ED) return visit rate data, the return visit rate following ED discharge for pediatric SCD pain treatment is currently unknown. PROCEDURE A seven-site retrospective cohort study of discharged ED visits for pain by children with SCD was conducted using the Pediatric Emergency Care Applied Research Network Registry. Visits between January 2017 and November 2021 were identified using previously validated criteria. The primary outcome was the 14-day return visit rate, with 3- and 7-day rates also calculated. Modified Poisson regression was used to analyze associations for age, sex, initial hospitalization rate, and a visit during the COVID-19 pandemic with return visit rates. RESULTS Of 2548 eligible ED visits, approximately 52% were patients less than 12 years old, 50% were female, and over 95% were non-Hispanic Black. The overall 14-day return visit rate was 29.1% (95% confidence interval [CI]: 27.4%-30.9%; site range 22.7%-31.7%); the 7- and 3-day return visit rates were 23.0% (95% CI: 21.3%-24.6%) and 16.7% (95% CI: 15.3%-18.2%), respectively. Younger children had slightly lower 14-day return visit rates (27.3% vs. 31.1%); there were no associations for site hospitalization rate, sex, and a visit occurring during the pandemic with 14-day returns. CONCLUSION Nearly 30% of ED discharged visits after SCD pain treatment had a return visit within 14 days. Increased efforts are needed to identify causes for high ED return visit rates and ensure optimal ED and post-ED care.
Collapse
Affiliation(s)
- Keli D. Coleman
- Medical College of Wisconsin and the Children’s Research Institute of Children’s Wisconsin, Department of Pediatrics, Section of Emergency Medicine, Milwaukee, WI, USA
| | | | - Angela M. Ellison
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Selena Hariharan
- University of Cincinnati College of Medicine, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - Irina Topoz
- Department of Pediatrics, Section of Emergency Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Morgan Wurtz
- Nationwide Children’s Hospital, Columbus, OH, USA
| | | | | | - Claudia R. Morris
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, GA, USA
| | - Amanda M. Brandow
- Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation, Medical College of Wisconsin and Children’s Research Institute of Children’s Wisconsin, Milwaukee, WI, USA
| | - Andrew D. Campbell
- Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DC, USA
| | - Robert I. Liem
- Division of Hematology, Oncology & Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Rachelle Nuss
- Center for Cancer and Blood Disorders, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Charles T. Quinn
- Division of Hematology, Cincinnati Children’s Hospital Med. Ctr., Cincinnati, OH, USA
| | | | | | - Allison A. King
- Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ana Baumann
- Washington University School of Medicine, St Louis, MO, USA
| | | | - David C Brousseau
- Nemours Children’s Health and Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, USA
| |
Collapse
|
4
|
Rees CA, Brousseau DC, Cohen DM, Villella A, Dampier C, Brown K, Campbell A, Chumpitazi CE, Airewele G, Chang T, Denton C, Ellison A, Thompson A, Ahmad F, Bakshi N, Coleman KD, Leibovich S, Leake D, Hatabah D, Wilkinson H, Robinson M, Casper TC, Vichinsky E, Morris CR. Sickle Cell Disease Treatment with Arginine Therapy (STArT): study protocol for a phase 3 randomized controlled trial. Trials 2023; 24:538. [PMID: 37587492 PMCID: PMC10433602 DOI: 10.1186/s13063-023-07538-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Despite substantial illness burden and healthcare utilization conferred by pain from vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD), disease-modifying therapies to effectively treat SCD-VOE are lacking. The aim of the Sickle Cell Disease Treatment with Arginine Therapy (STArT) Trial is to provide definitive evidence regarding the efficacy of intravenous arginine as a treatment for acute SCD-VOE among children, adolescents, and young adults. METHODS STArT is a double-blind, placebo-controlled, randomized, phase 3, multicenter trial of intravenous arginine therapy in 360 children, adolescents, and young adults who present with SCD-VOE. The STArT Trial is being conducted at 10 sites in the USA through the Pediatric Emergency Care Applied Research Network (PECARN). Enrollment began in 2021 and will continue for 5 years. Within 12 h of receiving their first dose of intravenous opioids, enrolled participants are randomized 1:1 to receive either (1) a one-time loading dose of L-arginine (200 mg/kg with a maximum of 20 g) administered intravenously followed by a standard dose of 100 mg/kg (maximum 10 g) three times a day or (2) a one-time placebo loading dose of normal saline followed by normal saline three times per day at equivalent volumes and duration as the study drug. Participants, research staff, and investigators are blinded to the participant's randomization. All clinical care is provided in accordance with the institution-specific standard of care for SCD-VOE based on the 2014 National Heart, Lung, and Blood Institute guidelines. The primary outcome is time to SCD-VOE pain crisis resolution, defined as the time (in hours) from study drug delivery to the last dose of parenteral opioid delivery. Secondary outcomes include total parental opioid use and patient-reported outcomes. In addition, the trial will characterize alterations in the arginine metabolome and mitochondrial function in children with SCD-VOE. DISCUSSION Building on the foundation of established relationships between emergency medicine providers and hematologists in a multicenter research network to ensure adequate participant accrual, the STArT Trial will provide definitive information about the efficacy of intravenous arginine for the treatment of SCD-VOE for children. TRIAL REGISTRATION The STArT Trial was registered in ClinicalTrials.gov on April 9, 2021, and enrollment began on June 21, 2021 (NCT04839354).
Collapse
Affiliation(s)
- Chris A Rees
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA, W45830322, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - David C Brousseau
- Department of Pediatrics, Nemours Children's Health Delaware and the Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, USA
| | | | | | - Carlton Dampier
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA, W45830322, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kathleen Brown
- Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Andrew Campbell
- Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Gladstone Airewele
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Todd Chang
- Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Christopher Denton
- Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Angela Ellison
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Fahd Ahmad
- Washington University in St. Louis, St. Louis, MO, USA
| | - Nitya Bakshi
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Keli D Coleman
- Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | | | | | - Dunia Hatabah
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA, W45830322, USA
| | | | | | | | - Elliott Vichinsky
- Center for Maternal-Fetal Precision Medicine, University of California, San Francisco, CA, USA
- Department of Pediatrics, UCSF-Benioff Children's Hospital-Oakland, Oakland, CA, USA
| | - Claudia R Morris
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA, W45830322, USA.
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
| |
Collapse
|
5
|
Rees CA, Brousseau DC, Ahmad FA, Bennett J, Bhatt S, Bogie A, Brown KM, Casper TC, Chapman LL, Chumpitazi CE, Cohen DM, Dampier C, Ellison AM, Grasemann H, Hickey RW, Hsu LL, Lane PA, Bakshi N, Leibovich S, Patil P, Powell EC, Richards R, Sarnaik S, Weiner DL, Morris CR. Adherence to NHLBI guidelines for the emergent management of vaso-occlusive episodes in children with sickle cell disease: A multicenter perspective. Am J Hematol 2022; 97:E412-E415. [PMID: 36054566 PMCID: PMC9561082 DOI: 10.1002/ajh.26696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - David C. Brousseau
- Children’s Research Institute of the Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Fahd A. Ahmad
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | | | - Seema Bhatt
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda Bogie
- Univesrsity of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | | | - Laura L. Chapman
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Corrie E. Chumpitazi
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Carlton Dampier
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Robert W. Hickey
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Lewis L. Hsu
- University of Illinois at Chicago, Chicago, Illinois
| | - Peter A. Lane
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Nitya Bakshi
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sara Leibovich
- UCSF-Benioff Children’s Hospital at Oakland, Oakland, California
| | | | - Elizabeth C. Powell
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rachel Richards
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | - Debra L. Weiner
- Division of Pediatric Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| |
Collapse
|