*Department of Pediatric Hematology/Oncology †Division of Hematology ‡Department of Pediatrics §Division of Oncology ∥Department of Hospital Medicine, Duke University Medical Center, Durham, NC.
Clin J Pain. 2014 Mar;30(3):266-8. doi: 10.1097/AJP.0b013e318295ec04.
Sickle cell disease (SCD) is a chronic disease characterized by multiple vaso-occlusive complications and is increasingly cared for by hospitalists. The purpose of this study is to examine differences in pain management between hematologists and hospitalists.
We performed a single-institution, retrospective review of pain management patterns and outcomes in adult SCD patients hospitalized for vaso-occlusive crisis.
Over 26 months, we found a total of 298 patients (120 cared for by the hematologists and 178 by hospitalists), with a mean age of 32 (range 19-58). Patients cared for by hospitalists had a lower total number of hours on a patient controlled analgesia (PCA) device (171 vs. 212 hours, P=0.11). Hospitalists also were significantly more likely to utilize demand only PCA (42% vs. 23%, P=0.002) and had a significantly lower rate of using both continuous and demand PCA (54% vs. 67%, P=0.04). In addition, patients cared for by hospitalists had a significantly shorter hospitalization (8.4 days) compared to hematologists (10 days, P=0.04) with a non-significant difference in 7 and 30 day readmission rates (7.2% vs. 6.7% and 40% vs. 35% respectively).
We found patients cared for by hospitalists more frequently utilized home oral pain medication during admission, had shorter lengths of hospitalization, and did not have a significant increase in readmission rates.
镰状细胞病（SCD）是一种慢性疾病，其特征为多种血管阻塞性并发症，并越来越多地由医院医生进行治疗。本研究的目的是研究血液病医生和医院医生在疼痛管理方面的差异。
我们对因血管阻塞性危象住院的成年 SCD 患者的疼痛管理模式和结局进行了单机构回顾性研究。
在 26 个月期间，我们共发现 298 例患者（120 例由血液病医生治疗，178 例由医院医生治疗），平均年龄为 32 岁（19-58 岁）。由医院医生治疗的患者使用患者自控镇痛（PCA）设备的总时间明显较短（171 小时与 212 小时，P=0.11）。医院医生更倾向于使用仅按需 PCA（42%比 23%，P=0.002），而使用连续和按需 PCA 的比例明显较低（54%比 67%，P=0.04）。此外，与血液病医生相比，由医院医生治疗的患者的住院时间明显缩短（8.4 天与 10 天，P=0.04），7 天和 30 天再入院率差异无统计学意义（分别为 7.2%比 6.7%和 40%比 35%）。
我们发现，由医院医生治疗的患者在住院期间更频繁地使用家庭口服止痛药，住院时间更短，再入院率没有显著增加。
