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Emergency management of SCD pain crises: Current practices and playing variables

机译:SCD疼痛危机的应急管理:当前做法和变量

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Introduction/Objectives Acute pain episode is a common reason for patients with sickle cell disease to present to the Emergency Room. This study is designed to assess the role of multiple factors that might affect the time from Emergency Department triage to the administration of the first opiate pain medication and its dosage, to compare current practices with the American Pain Society Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in the Emergency Department. By identifying and recognizing some of the factors that delay or affect the proper dosing of the pain medications, we aim to implement suitable and plausible changes to ensure better emergency care for these sickle cell disease patients. Methodology This is a cross-sectional retrospective descriptive study that relied on collecting non-identifiable data from the local Electronic Medical Record to assess for possible relationship between the proposed set of factors/variables and the time to administration of the 1st pain medication and it's dosage. The population in question includes the entire sickle cell disease patients' population (HB-SS, HB-SC, HB-SD, HB-SB + and HB-SB 0 ) that are under the care of our Pediatric Hematology-Oncology clinic with the age range of 1 day–21 years. The factors include age, gender, pain assessment/scale, time of presentation, mode of arrival, presence or absence of IV access at presentation, and ESI acuity. Results There were 259 patient Emergency Room visits with 148 unique patients. Mean (SD) age of the entire study population was 15.98 (±4.08) years and 61.8% of the patients were females. Average time to 1st opiate pain medication was 120.27?min (SD?±?78.4) and average doses of Morphine and Hydromorphone were 0.067?mg/kg and 0.053?mg/kg respectively. Longer waiting time to 1st opiate pain medication were found in females with a mean difference of 25.5?min (95% CI 20–80.5? P value 0.027 ), older patients and patients with least severity ESI score (correlation coefficient of 0.214 & 0.134 (p values of 0.001 and 0.031) respectively). On the other hand, there seems to be a negative correlation between the time to 1st opiate and the pain score with a negative correlation coefficient of??0.22 (p value of < 0.001) . Conclusion Overall, patients with acute SCD pain experienced significant delays when seeking pain relief in the Emergency Department. The following patients experienced the longest delays: those assigned a lower triage priority level, female patients, patients with lower pain score and older patients.
机译:简介/目的急性疼痛发作是镰状细胞病患者出现在急诊室的常见原因。这项研究旨在评估可能影响从急诊科分诊到首次使用阿片类止痛药的时间及其剂量的多种因素的作用,以将当前实践与美国疼痛学会急性和慢性管理指南进行比较急诊科的镰状细胞病疼痛。通过识别和认识到一些延迟或影响止痛药正确剂量的因素,我们旨在实施适当而合理的更改,以确保为这些镰状细胞病患者提供更好的紧急护理。方法学这是一项横断面回顾性描述性研究,依靠从本地电子病历收集无法识别的数据来评估提议的一组因素/变量与第一种止痛药的给药时间及其剂量之间的可能关系。 。所涉及的人群包括整个镰状细胞病患者的人群(HB-SS,HB-SC,HB-SD,HB-SB +和HB-SB 0),这些人群均由我们的儿科血液肿瘤诊所负责年龄范围为1天至21岁。这些因素包括年龄,性别,疼痛评估/程度,就诊时间,到达方式,就诊时是否存在静脉通路以及ESI视力。结果共有259位急诊室就诊者和148位独特患者。整个研究人群的平均(SD)年龄为15.98(±4.08)岁,其中61.8%的患者为女性。第一次服用阿片类止痛药的平均时间为120.27?min(SD?±?78.4),吗啡和氢吗啡酮的平均剂量分别为0.067?mg / kg和0.053?mg / kg。女性中平均第一次使用鸦片类止痛药的等待时间更长,平均差异为25.5?min(95%CI 20-80.5?P值0.027),老年患者和ESI评分最低的患者(相关系数为0.214和0.134( p值分别为0.001和0.031)。另一方面,到第一个鸦片鸦片的时间与疼痛评分之间似乎存在负相关,其负相关系数为Δβ0.22(p值<0.001)。结论总体而言,急性SCD疼痛患者在急诊科寻求缓解疼痛的时间明显延迟。以下患者经历了最长的延迟:分配较低优先诊治等级的患者,女性患者,疼痛评分较低的患者和年龄较大的患者。

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