Department of Pediatrics, Pediatric Pain and Palliative Care Service, Azienda Ospedaliera-University of Padova, Padova, Italy.
Clin J Pain. 2013 Jan;29(1):60-3. doi: 10.1097/AJP.0b013e318245764b.
Pain is the most common reason for admission to the Emergency Department (ED) in patients with sickle cell disease (SCD). It can be associated with severe complications and impairs quality of life. Pain management in the ED should be well-defined and aggressive. The objective of this study was to evaluate pain management in the pediatric ED of a country recently facing SCD and to identify priority areas of intervention.
The charts of SCD children who had accessed the ED from January 2003 to December 2010 were retrospectively reviewed. Pain management was compared before and after 2008. During 2008, educational events on SCD-pain management involved the ED personnel.
Twenty-three/28 patients (82%) accessed the ED for/with pain, of a total of 96/185 accesses for/with pain. Mean age was 5.9 years (range, 8 mo to 17.9 y). Fifty-four percent of the episodes resulted in hospital admissions, with a mean length of stay of 6.2 days. Pain was scored in 30% of the episodes; analgesics were administered in 50%. After the educational interventions, high score at triage was assigned more frequently (72% vs. 40%), waiting time for analgesics administration reduced (64 vs. 87 min), and use of Visual Analogue Scale increased (50% vs. 8%).
Pain represents the main reason for admission to the ED in children with SCD even in countries recently facing SCD. Educational interventions obtained significant but still limited improvement in pain management. The diffusion of national guidelines with defined pain evaluation and treatment protocols represents a priority to further ameliorate care of SCD children.
在患有镰状细胞病（SCD）的患者中，疼痛是急诊科（ED）就诊的最常见原因。它可能与严重并发症有关，并会降低生活质量。ED 中的疼痛管理应明确且积极。本研究的目的是评估一个最近面临 SCD 国家的儿科 ED 中的疼痛管理，并确定干预的优先领域。
回顾性分析了 2003 年 1 月至 2010 年 12 月期间进入 ED 的 SCD 儿童的病历。比较了 2008 年前后的疼痛管理情况。2008 年期间，对 ED 人员进行了有关 SCD 疼痛管理的教育活动。
共有 28 名患者（总数为 185 名）因疼痛或伴有疼痛进入 ED，其中 23 名患者（82%）因疼痛或伴有疼痛进入 ED。平均年龄为 5.9 岁（范围 8 个月至 17.9 岁）。54%的发作导致住院，平均住院时间为 6.2 天。30%的发作有疼痛评分，50%的发作给予了镇痛剂。在教育干预后，更频繁地对分诊进行了高分评估（72%对 40%），镇痛剂给药的等待时间缩短（64 分钟对 87 分钟），视觉模拟量表的使用率增加（50%对 8%）。
即使在最近面临 SCD 的国家，疼痛也是 SCD 儿童进入 ED 的主要原因。教育干预在疼痛管理方面取得了显著但仍有限的改善。传播国家指南，制定明确的疼痛评估和治疗方案，是进一步改善 SCD 儿童护理的优先事项。
