Aisiku Imoigele P, Smith Wally R, McClish Donna K, Levenson James L, Penberthy Lynne T, Roseff Susan D, Bovbjerg Viktor E, Roberts John D
Department of Anesthesiology, Virginia Commonwealth University Reanimation Engineering Shock Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
Ann Emerg Med. 2009 May;53(5):587-93. doi: 10.1016/j.annemergmed.2008.07.050. Epub 2008 Oct 16.
Patients with sickle cell disease often receive a substantial amount of their health care in the emergency department (ED) and some come to the ED frequently, seeking treatment for pain. As a result, patients with sickle cell disease are often stigmatized as opioid-seeking ED overutilizers. We describe the proportion of sickle cell disease patients who are high utilizers of the ED and compare them with other sickle cell disease patients on demographics, pain characteristics, health data, psychosocial characteristics, and quality of life.
Two hundred thirty-two patients completed baseline data and at least 30 days of daily diary data. Baseline data included demographics, health data, and quality of life (Medical Outcome Study 36 Item Short Form). Daily diary data included ED utilization for sickle cell pain and descriptors of pain and distress.
Eighty-two (35.5%) patients were found to be high ED utilizers. Clinically important and statistically significant differences were found between high ED utilizers and all other sickle cell disease patients: lower hematocrit level, more transfusions, more pain days, more pain crises, higher mean pain and distress, and worse quality of life on Medical Outcome Study 36 Item Short Form physical function summary scales. After controlling for severity and frequency of pain, high ED utilizers did not use opioids more frequently than other sickle cell disease patients.
A substantial minority of sickle cell disease patients are high ED utilizers. However, high ED utilizers with sickle cell disease are more severely ill as measured by laboratory variables, have more pain, more distress, and have a lower quality of life.
镰状细胞病患者常在急诊科接受大量医疗服务，部分患者频繁前往急诊科寻求疼痛治疗。因此，镰状细胞病患者常被污名化为寻求阿片类药物的急诊科过度使用者。我们描述了急诊科高使用率的镰状细胞病患者比例，并将他们与其他镰状细胞病患者在人口统计学、疼痛特征、健康数据、心理社会特征和生活质量方面进行比较。
232名患者完成了基线数据以及至少30天的每日日记数据。基线数据包括人口统计学、健康数据和生活质量（医学结局研究36项简表）。每日日记数据包括因镰状细胞疼痛而使用急诊科的情况以及疼痛和痛苦的描述。
发现82名（35.5%）患者为急诊科高使用率患者。在急诊科高使用率患者与所有其他镰状细胞病患者之间发现了具有临床重要性和统计学显著性的差异：血细胞比容水平较低、输血次数更多、疼痛天数更多、疼痛危象更多、平均疼痛和痛苦程度更高，以及在医学结局研究36项简表身体功能汇总量表上的生活质量更差。在控制疼痛的严重程度和频率后，急诊科高使用率患者使用阿片类药物的频率并不比其他镰状细胞病患者更高。
相当一部分镰状细胞病患者是急诊科高使用率患者。然而，从实验室指标衡量，镰状细胞病的急诊科高使用率患者病情更严重，疼痛更多，痛苦更多，生活质量更低。
