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Kazadi C, Ducruet T, Forté S, Robitaille N, Pastore Y. Positive impacts of universal newborn screening on the outcome of children with sickle cell disease in the province of Quebec: A retrospective cohort study. EJHAEM 2024; 5:447-454. [PMID: 38895082 PMCID: PMC11182396 DOI: 10.1002/jha2.926] [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] [Received: 02/19/2024] [Revised: 04/28/2024] [Accepted: 05/01/2024] [Indexed: 06/21/2024]
Abstract
A universal newborn screening program for sickle cell disease (uNS-SCD) was implemented in the province of Québec (Qc) in November 2013, close in time to the recommendation of early initiation of hydroxyurea (HU) therapy for children. This retrospective cohort study evaluated the impact of such a program on children first seen between January 2000 and December 2019. Cohorts pre-SCD-uNS in Qc (pre-QcNS) (n = 253) and post-QcNS (n = 157) for patients seen prior to or after Nov 2013 were compared. Kaplan-Meier curves, Poisson regression, and logistic regressions were used for statistical analysis, using Software R version 4.2.1. Median age at first visit decreased significantly from 14.4 [interquartile range: 2.4-72.0] to 1.2 months [1.2-57.6] (p < 0.001). The percentage of children born in Qc undiagnosed at birth and referred after a first SCD-related complication dropped from 42.6% to 0.0% (p < 0.0001). The median age of HU introduction for patients with SS/Sβ°-thalassemia decreased from 56.4 [31.2-96.0] to 9.0 months post-QcNS [8.0-12.1] (p < 0.001). Event-free survival improved significantly for any type of hospitalization as well as for vaso-occlusive crisis (VOC) (140-257 days (p < 0.001) and 1320 vs. 573 days (p < 0.002), respectively), resulting in a reduction from 2 [interquartile range: 1.0-3.0] to 1.0 hospitalizations/patient-year [0.6-1.4] (p < 0.001). Children with SS/Sβ°-thalassemia referred post-QcNS also had fewer emergency department visits for VOC (RR: 0.69, 95% confidence interval: 0.54-0.88). The Universal NS program allows early detection and referral of children with SCD to comprehensive care centers. Earlier access ensures that children benefit from essential preventive interventions, reducing disease burden. This cohort study highlights that uNS-SCD is an essential public health measure.
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Affiliation(s)
- Costa Kazadi
- Department of PediatricsDivision of Hematology‐OncologyCentre Hospitalier Universitaire Sainte‐JustineMontrealCanada
- Department of MedicineDivision of Hematology‐OncologyCHUMMontrealCanada
| | - Thierry Ducruet
- Unité de Recherche Clinique Appliquée (URCA)Centre Hospitalier Universitaire Sainte‐Justine Research CenterMontrealCanada
| | - Stéphanie Forté
- Department of PediatricsDivision of Hematology‐OncologyCentre Hospitalier Universitaire Sainte‐JustineMontrealCanada
- Department of MedicineDivision of Hematology‐OncologyCHUMMontrealCanada
- Carrefour de l'InnovationCHUMMontrealCanada
| | - Nancy Robitaille
- Department of PediatricsDivision of Hematology‐OncologyCentre Hospitalier Universitaire Sainte‐JustineMontrealCanada
- University of MontréalMontrealCanada
- Hema‐QuebecTransfusion MedicineMontrealCanada
| | - Yves Pastore
- Department of PediatricsDivision of Hematology‐OncologyCentre Hospitalier Universitaire Sainte‐JustineMontrealCanada
- University of MontréalMontrealCanada
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2
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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, Hatabah D, Hickey RW, Hsu LL, Bakshi N, Leibovich S, Patil P, Powell EC, Richards R, Sarnaik S, Weiner DL, Morris CR. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol 2023; 98:620-627. [PMID: 36606705 PMCID: PMC10023395 DOI: 10.1002/ajh.26837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/23/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
Children with sickle cell disease (SCD) commonly experience vaso-occlusive pain episodes (VOE) due to sickling of erythrocytes, which often requires care in the emergency department. Our objective was to assess the use and impact of intranasal fentanyl for the treatment of children with SCD-VOE on discharge from the emergency department in a multicenter study. We conducted a cross-sectional study at 20 academic pediatric emergency departments in the United States and Canada. We used logistic regression to test bivariable and multivariable associations between the outcome of discharge from the emergency department and candidate variables theoretically associated with discharge. The study included 400 patients; 215 (54%) were female. The median age was 14.6 (interquartile range 9.8, 17.6) years. Nineteen percent (n = 75) received intranasal fentanyl in the emergency department. Children who received intranasal fentanyl had nearly nine-fold greater adjusted odds of discharge from the emergency department compared to those who did not (adjusted odds ratio 8.99, 95% CI 2.81-30.56, p < .001). The rapid onset of action and ease of delivery without intravenous access offered by intranasal fentanyl make it a feasible initial parenteral analgesic in the treatment of children with SCD presenting with VOE in the acute-care setting. Further study is needed to determine potential causality of the association between intranasal fentanyl and discharge from the emergency department observed in this multicenter study.
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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
- Section of Pediatric Emergency Medicine, Medical College of Wisconsin and the 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
| | | | | | - Dunia Hatabah
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Robert W. Hickey
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Lewis L. Hsu
- University of Illinois at Chicago, Chicago, Illinois
| | - 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, GA
| | - 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
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Lapite A, Lavina I, Goel S, Umana J, Ellison AM. A Qualitative Systematic Review of Pediatric Patient and Caregiver Perspectives on Pain Management for Vaso-Occlusive Episodes in the Emergency Department. Pediatr Emerg Care 2023; 39:162-166. [PMID: 36790450 DOI: 10.1097/pec.0000000000002913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The primary objective of this study is to describe the experiences of pediatric patients with sickle cell disease (SCD) and their caregivers who have presented to the emergency department (ED) for management of vaso-occlusive pain events. METHODS We conducted a qualitative systematic review. The search protocol was developed to identify both published and unpublished literature that met inclusion/exclusion criteria. Included articles were primary hospital-based research with study populations that included (but were not limited to) pediatric patients aged 21 years or younger and qualitative or mixed-method analysis. RESULTS Four themes were identified: (1) patients and caregivers perceive the ED as the last resort; (2) health care professionals in the ED lacked knowledge about SCD but rejected patients' and caregiver's attempts to share experience or advocate for their needs; (3) patients' accounts of pain are doubted because they do not always have "typical" signs of pain; and (4) caregivers identify racism as a reason for suboptimal care in the ED. CONCLUSIONS There are multiple opportunities to improve management for vaso-occlusive pain events in the ED, including education of health care providers about SCD and complications, partnership between patients/caregivers and providers, and efforts to reduce the impact of systemic racism on health care delivery.
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Affiliation(s)
- Ajibike Lapite
- From the Cancer and Hematology Center, Texas Children's Hospital, Houston, TX
| | - Ilana Lavina
- Department of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Swati Goel
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jasmine Umana
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Angela M Ellison
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
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Ojo AS, Odipe OG, Owoseni O. Improving the Emergency Department Management of Sickle Cell Vaso-Occlusive Pain Crisis: The Role and Options of Sublingual and Intranasally Administered Analgesia. J Clin Med Res 2023; 15:10-22. [PMID: 36755761 PMCID: PMC9881494 DOI: 10.14740/jocmr4841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/10/2022] [Indexed: 01/26/2023] Open
Abstract
Vaso-occlusive crisis (VOC), characterized by periods of excruciating pain is the most common clinical manifestation of sickle cell disease (SCD), often resulting in emergency room presentation. These patients often experience long wait times in the emergency department before receiving their first dose of analgesia. This delay results from the complexities of the emergency care system. Using the intranasal or sublingual approach to administering analgesia to SCD patients with VOC offers a fast, safe, noninvasive, atraumatic, and easily accessible route of administration which could reduce the time to first dose of analgesia. With the evolving advances in the development and delivery of analgesic medications, providers should be conversant with the nuances of intranasal and sublingual analgesia in the management of acute vaso-occlusive pain crisis. This review explores the pharmacokinetic profiles, dosages, and administration of intranasal and sublingual analgesics with relevance to the SCD population.
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Affiliation(s)
- Ademola S. Ojo
- Department of Medicine, Howard University Hospital, Washington DC, USA,Corresponding Author: Ademola S. Ojo, Department of Internal Medicine, Howard University Hospital, Washington DC, USA.
| | - Olumayowa G. Odipe
- Department of Pediatrics and Child Health, Queen’s Medical Center, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Oluwanifemi Owoseni
- Department of Pharmaceutical Sciences, Howard University College of Pharmacy, Washington DC, USA
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Trottier ED, Ali S, Doré-Bergeron MJ, Chauvin-Kimoff L. Les pratiques exemplaires pour l’évaluation et le traitement de la douleur chez les enfants. Paediatr Child Health 2022; 27:429-448. [PMCID: PMC9732860 DOI: 10.1093/pch/pxac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Résumé
L’évaluation et le traitement de la douleur sont des aspects essentiels des soins pédiatriques. L’évaluation de la douleur adaptée au développement représente une première étape importante pour en optimiser la prise en charge. L’autoévaluation de la douleur est à prioriser. Si c’est impossible, des outils appropriés d’évaluation du comportement, adaptés au développement, doivent être utilisés. Des directives et stratégies de prise en charge et de prévention de la douleur aiguë, qui combinent des approches physiques, psychologiques et pharmacologiques, doivent être accessibles dans tous les milieux de soins. Le meilleur traitement de la douleur chronique fait appel à une combinaison de modalités thérapeutiques et de counseling, dans l’objectif premier d’obtenir une amélioration fonctionnelle. La planification et la mise en œuvre de stratégies de prise en charge de la douleur chez les enfants doivent toujours être personnalisées et axées sur la famille.
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Affiliation(s)
- Evelyne D Trottier
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| | - Samina Ali
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| | - Marie-Joëlle Doré-Bergeron
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| | - Laurel Chauvin-Kimoff
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
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Trottier ED, Ali S, Doré-Bergeron MJ, Chauvin-Kimoff L. Best practices in pain assessment and management for children. Paediatr Child Health 2022; 27:429-448. [PMID: 36524020 PMCID: PMC9732859 DOI: 10.1093/pch/pxac048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/14/2022] [Indexed: 09/04/2023] Open
Abstract
Pain assessment and management are essential components of paediatric care. Developmentally appropriate pain assessment is an important first step in optimizing pain management. Self-reported pain should be prioritized. Alternatively, developmentally appropriate behavioural tools should be used. Acute pain management and prevention guidelines and strategies that combine physical, psychological, and pharmacological approaches should be accessible in all health care settings. Chronic pain is best managed using combined treatment modalities and counselling, with the primary goal of attaining functional improvement. The planning and implementation of pain management strategies for children should always be personalized and family-centred.
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Affiliation(s)
- Evelyne D Trottier
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| | - Samina Ali
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| | - Marie-Joëlle Doré-Bergeron
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| | - Laurel Chauvin-Kimoff
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
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Moore J, Yeung HM. Treatment of acute pain episodes: A prisoner's dilemma. Acad Emerg Med 2022; 29:1508-1511. [PMID: 36251719 DOI: 10.1111/acem.14607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/14/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Jessica Moore
- Department of Emergency Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Ho-Man Yeung
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
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Fusetti V, Re L, Pigni A, Tallarita A, Cilluffo S, Caraceni AT, Lusignani M. Clown therapy for procedural pain in children: a systematic review and meta-analysis. Eur J Pediatr 2022; 181:2215-2225. [PMID: 35294645 DOI: 10.1007/s00431-022-04440-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 12/16/2022]
Abstract
UNLABELLED Among the distraction techniques used for the non-pharmacological management of acute pediatric pain, one of the most performed is clown therapy. Despite the presence in the literature of some systematic reviews that evaluate its effectiveness, none of them examines its outcomes on procedural pain which has therefore been investigated in this study. The literature search for randomized controlled trials (RCTs) was performed on the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus over a time frame ranging from each database setup date to 31 July 2021. The primary outcome was the procedural pain of children. We used the Cochrane Risk of Bias tool to assess the risk of bias of the included studies. Six RCTs were selected for this review, which included a total of 517 pediatric subjects. Children undergoing clown therapy during the venipuncture or peripheral vein cannulation procedure reported less pain than those exposed to the standard of care (SMD = -0.55; 95% CI: -1.23, 0.13) but the result was not found to be statistically significant. School-aged children and adolescent reported significantly less pain (SMD = -0.51; 95% CI: -0.92, -0.09). Compared to the standard of care, children's anxiety was significantly lower with clown therapy (SMD = -0.97; 95% CI: -1.38, -0.56). CONCLUSION Clown therapy seems effective in reducing procedural pain in children, particularly for older age groups, but due to poor methodological quality and the high risk of bias of the studies included, the results obtained should be considered with caution. WHAT IS KNOWN • Clown therapy is one of the most used techniques in the non-pharmacological management of acute pediatric pain. • Laughter physiologically stimulates the production of beta-endorphins, substances with an effect similar to opiates. WHAT IS NEW • Clown therapy seems effective in reducing procedural pain and anxiety in children. • The intervention in school-age children or adolescents produces a statistically significant decrease in the symptom.
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Affiliation(s)
- Viviana Fusetti
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
- Università Degli Studi di Roma, Tor Vergata, Roma, Italy.
| | - Luca Re
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Alessandra Pigni
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Antonino Tallarita
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Silvia Cilluffo
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Augusto Tommaso Caraceni
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Maura Lusignani
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
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Beck CE, Trottier ED, Kirby-Allen M, Pastore Y. La prévention et la prise en charge des complications aiguës de l'anémie falciforme. Paediatr Child Health 2022; 27:50-62. [PMID: 35273672 PMCID: PMC8900702 DOI: 10.1093/pch/pxab095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
L'anémie falciforme est une maladie multisystémique chronique qui exige des soins globaux. La falciformation des globules rouges entraîne une hémolyse et une occlusion vasculaire. L'anémie hémolytique, les syndromes douloureux et les atteintes organiques en sont des complications. En raison des profils d'immigration et d'une augmentation du dépistage néonatal, les professionnels de la santé pédiatrique du Canada doivent connaître l'anémie falciforme, tant dans les petits que les grands centres. Le présent document de principes porte sur les principes de prévention, de défense d'intérêts et de traitement rapide des complications aiguës courantes de l'anémie falciforme. Les lignes directrices comprennent l'état actuel du dépistage néonatal, les recommandations en matière de vaccination et de prophylaxie antibiotique et une introduction à l'hydroxyurée, un médicament qui réduit à la fois la morbidité et la mortalité chez les enfants atteints d'anémie falciforme. Des scénarios cliniques démontrent les principes de soins en cas de complications aiguës courantes : les épisodes vaso-occlusifs, le syndrome thoracique aigu, la fièvre, la séquestration splénique, les crises aplasiques et les accidents vasculaires cérébraux. Enfin, les principes de transfusion sanguine sont présentés, de même que les indications de transfusion simple ou d'exsanguinotransfusion.
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Affiliation(s)
- Carolyn E Beck
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario) Canada
| | - Evelyne D Trottier
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario) Canada
| | - Melanie Kirby-Allen
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario) Canada
| | - Yves Pastore
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario) Canada
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Beck CE, Trottier ED, Kirby-Allen M, Pastore Y. Acute complications in children with sickle cell disease: Prevention and management. Paediatr Child Health 2022; 27:50-62. [PMID: 35273671 PMCID: PMC8900682 DOI: 10.1093/pch/pxab096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) is a chronic, multi-system disease that requires comprehensive care. The sickling of red blood cells leads to hemolysis and vascular occlusion. Complications include hemolytic anemia, pain syndromes, and organ damage. Patterns of immigration and an increase in newborn screening mean that paediatric health care providers across Canada, in small and large centres alike, need to be knowledgeable about SCD. This statement focuses on principles of prevention, advocacy, and the rapid treatment of common acute complications. Guidance includes the current status of newborn screening, recommendations for immunizations and antibiotic prophylaxis, and an introduction to hydroxyurea, a medication that reduces both morbidity and mortality in children with SCD. Case vignettes demonstrate principles of care for common acute complications of SCD: vaso-occlusive episodes (VOE), acute chest syndrome (ACS), fever, splenic sequestration, aplastic crises, and stroke. Finally, principles of blood transfusion are highlighted, along with indications for both straight and exchange blood transfusions.
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Affiliation(s)
- Carolyn E Beck
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Evelyne D Trottier
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | | | - Yves Pastore
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
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Arbitre C, Pastore Y, Bailey B, Kleiber N, Robitaille N, Villeneuve E, Viau A, Bergeron MJ, Trottier ED. Evaluation of Vaso-occlusive Crisis Management With Patient-Controlled Analgesia in Children With Sickle Cell Disease Requiring Hospitalization. J Pediatr Pharmacol Ther 2021; 26:615-623. [PMID: 34421412 DOI: 10.5863/1551-6776-26.6.615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/14/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to review the use of patient-controlled analgesia (PCA) in sickle cell disease (SCD) for pediatric patients with vaso-occlusive crisis (VOC) in our institution and to compare the effect of early vs late PCA start on pain relief and LOS. METHODS This retrospective study included all pediatric patients treated with PCA for a severe VOC from 2010 to 2016. "Early-PCA" was defined as start of PCA within 48 hours of arrival. Time to reach adequate analgesia was defined as the time to reach 2 consecutive pain scores less than 5/10 at 4-hour interval. RESULTS During the study period, 46 patients presented 87 episodes of VOC treated with PCA. Sixty-three patients with VOC were treated with Early-PCA and 24 with Late-PCA. Both groups were comparable except for median pain score at admission; the Early-PCA group had higher scores: 9.0/10 vs 7.0/10. Time to reach adequate analgesia could be evaluated only in a subset of patients (n = 32) but was shorter in the Early-PCA group with a median difference of 41.0 hours (95% CI -82.0 to -6.0). Early-PCA was associated with a median reduction in LOS of 3.4 days (95% CI -4.9 to -1.9). There was no difference between the 2 groups in terms of side effects and occurrence of acute chest syndrome during hospitalization. CONCLUSIONS In this study, a reduced time to reach adequate analgesia and LOS was noted in the Early-PCA group for severe VOC. A prospective study is required to confirm these results.
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Hejazi RA, Mandourah NA, Alsulami AS, Bakhsh HT, Diri RM, Noor AO. Commonly used agent for acute pain management of sickle cell anemia in Saudi Emergency Department: A narrative review. Saudi Pharm J 2021; 29:487-496. [PMID: 34194255 PMCID: PMC8233527 DOI: 10.1016/j.jsps.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Sickle-cell disease (SCD) is one of the most common hematologic inherited disorders in Saudi Arabia. Vaso-occlusive pain crisis in SCD is a major cause for emergency visits and patients' pain may be undertreated. This study presents a narrative literature review of current agents used to manage acute pain crisis in SCD patients presenting to the emergency department in hospitals of Saudi Arabia. METHOD We conducted a narrative review on relevant published articles about sickle cell disease pain crisis management in Saudi Arabia and included seven relevant studies based on our inclusion criteria. RESULTS Using our search strategy, we included 7 studies Out of 4052. Studies included were conducted in different locations in the country. Four studies were in the Eastern region while only one in Western and One in Central regions. Those studies included around 2441 patients, in total. Morphine was used in 5 studies out of the 7 included. Pethidine was used in 4. One study used Isoxsuprine and another study used tinzaparin. CONCLUSION We found that continuous administration of IV morphine accompanied by oral analgesics including NSAIDs and acetaminophen is the most commonly used practice for treating SCD patients presenting with a vaso-occlusive pain crisis. Possible effectiveness of tinzaparin, isoxsuprine, and pethidine as therapeutic options may be considered. However, there was no recommendation for a certain agent to be prescribed. We recommend conducting further clinical randomized-controlled trials.
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Affiliation(s)
| | | | | | - Hussain T. Bakhsh
- Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reem M. Diri
- Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad O. Noor
- Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
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