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Use of a clinical pathway to improve the acute management of vaso-occlusive crisis pain in pediatric sickle cell disease.
Pediatr Blood Cancer. 2014 Apr; 61(4):693-6.PB

Abstract

BACKGROUND

The most common, debilitating morbidity of sickle cell disease (SCD) is vaso-occlusive crisis (VOC) pain. Although guidelines exist for its management, they are generally not well-followed, and research in other pediatric diseases has shown that clinical pathways improve care. The purpose of our study was to determine whether a clinical pathway improves the acute management of sickle cell vaso-occlusive crisis (VOC) pain in the pediatric emergency department (PED).

PROCEDURE

Pain management practices were prospectively investigated before and after the initiation of a clinical pathway in the PED of an urban, tertiary care center with 50,000 ED visits per year and approximately 200 active sickle cell patients. The pathway included instructions for triage, monitoring, medication administration, and timing of assessments and interventions. Data were eligible from 35 pre-pathway and 33 post-pathway visits. Primary outcome was time interval to administration of first analgesic medication. Statistical analysis was by Student's t-test, using natural-log-transformed data for outcomes with skewed distribution curves.

RESULTS

Time interval to first analgesic improved from 74 to 42 minutes (P = 0.012) and to first opioid from 94 to 46 minutes (P = 0.013). The percentage of patients who received ketorolac increased from 57% to 82% (P = 0.03). Decrease in time interval to subsequent pain score assessment was not statistically significant (110 to 72 minutes (P = 0.07)), and change in pain score was not different (P = 0.25).

CONCLUSIONS

The use of a clinical pathway for sickle cell VOC in the PED can improve important aspects of pain management and merits further investigation and implementation.

Authors+Show Affiliations

Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Columbia University, Medical Center, New York, New York.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24249617

Citation

Ender, Katherine L., et al. "Use of a Clinical Pathway to Improve the Acute Management of Vaso-occlusive Crisis Pain in Pediatric Sickle Cell Disease." Pediatric Blood & Cancer, vol. 61, no. 4, 2014, pp. 693-6.
Ender KL, Krajewski JA, Babineau J, et al. Use of a clinical pathway to improve the acute management of vaso-occlusive crisis pain in pediatric sickle cell disease. Pediatr Blood Cancer. 2014;61(4):693-6.
Ender, K. L., Krajewski, J. A., Babineau, J., Tresgallo, M., Schechter, W., Saroyan, J. M., & Kharbanda, A. (2014). Use of a clinical pathway to improve the acute management of vaso-occlusive crisis pain in pediatric sickle cell disease. Pediatric Blood & Cancer, 61(4), 693-6. https://doi.org/10.1002/pbc.24864
Ender KL, et al. Use of a Clinical Pathway to Improve the Acute Management of Vaso-occlusive Crisis Pain in Pediatric Sickle Cell Disease. Pediatr Blood Cancer. 2014;61(4):693-6. PubMed PMID: 24249617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of a clinical pathway to improve the acute management of vaso-occlusive crisis pain in pediatric sickle cell disease. AU - Ender,Katherine L, AU - Krajewski,Jennifer A, AU - Babineau,John, AU - Tresgallo,Mary, AU - Schechter,William, AU - Saroyan,John M, AU - Kharbanda,Anupam, Y1 - 2013/11/19/ PY - 2013/02/06/received PY - 2013/10/24/accepted PY - 2013/11/20/entrez PY - 2013/11/20/pubmed PY - 2014/4/9/medline KW - clinical pathway KW - pain KW - sickle cell KW - vaso-occlusive crisis SP - 693 EP - 6 JF - Pediatric blood & cancer JO - Pediatr Blood Cancer VL - 61 IS - 4 N2 - BACKGROUND: The most common, debilitating morbidity of sickle cell disease (SCD) is vaso-occlusive crisis (VOC) pain. Although guidelines exist for its management, they are generally not well-followed, and research in other pediatric diseases has shown that clinical pathways improve care. The purpose of our study was to determine whether a clinical pathway improves the acute management of sickle cell vaso-occlusive crisis (VOC) pain in the pediatric emergency department (PED). PROCEDURE: Pain management practices were prospectively investigated before and after the initiation of a clinical pathway in the PED of an urban, tertiary care center with 50,000 ED visits per year and approximately 200 active sickle cell patients. The pathway included instructions for triage, monitoring, medication administration, and timing of assessments and interventions. Data were eligible from 35 pre-pathway and 33 post-pathway visits. Primary outcome was time interval to administration of first analgesic medication. Statistical analysis was by Student's t-test, using natural-log-transformed data for outcomes with skewed distribution curves. RESULTS: Time interval to first analgesic improved from 74 to 42 minutes (P = 0.012) and to first opioid from 94 to 46 minutes (P = 0.013). The percentage of patients who received ketorolac increased from 57% to 82% (P = 0.03). Decrease in time interval to subsequent pain score assessment was not statistically significant (110 to 72 minutes (P = 0.07)), and change in pain score was not different (P = 0.25). CONCLUSIONS: The use of a clinical pathway for sickle cell VOC in the PED can improve important aspects of pain management and merits further investigation and implementation. SN - 1545-5017 UR - https://www.unboundmedicine.com/medline/citation/24249617/Use_of_a_clinical_pathway_to_improve_the_acute_management_of_vaso_occlusive_crisis_pain_in_pediatric_sickle_cell_disease_ L2 - https://doi.org/10.1002/pbc.24864 DB - PRIME DP - Unbound Medicine ER -