Santos Josue, Jones Sasia, Wakefield Daniel, Grady James, Andemariam Biree
New England Sickle Cell Institute, Division of Hematology-Oncology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
Connecticut Institute for Clinical and Translational Science, 263 Farmington Avenue, Farmington, CT 06030, USA.
Pain Res Manag. 2016;2016:3218186. doi: 10.1155/2016/3218186. Epub 2016 Mar 29.
Background. A treatment algorithm for sickle cell disease (SCD) pain in adults presenting to a single emergency department (ED) was developed prioritizing initiation of patient controlled analgesia (PCA) for patients awaiting hospitalization. Objectives. Evaluate the proportion of ED visits in which PCA was started in the ED. Methods. A two-year retrospective chart review of consecutive SCD pain ED visits was undertaken. Data abstracted included PCA initiation, low versus high utilizer status, pain scores, bolus opioid number, treatment times, and length of hospitalization. Results. 258 visits resulted in hospitalization. PCA was initiated in 230 (89%) visits of which 157 (68%) were initiated in the ED. Time to PCA initiation was longer when PCA was begun after hospitalization versus in the ED (8.6 versus 4.5 hours, p < 0.001). ED PCA initiation was associated with fewer opioid boluses following decision to admit and less time without analgesic treatment (all p < 0.05). Mean pain intensity (MPI) reduction did not differ between groups. Among visits where PCA was begun in the ED, low utilizers demonstrated greater MPI reduction than high utilizers (2.8 versus 2.0, p = 0.04). Conclusions. ED PCA initiation for SCD-related pain is possible and associated with more timely analgesic delivery.
背景。针对就诊于单一急诊科（ED）的成年镰状细胞病（SCD）患者疼痛，制定了一种治疗算法，优先为等待住院的患者启动患者自控镇痛（PCA）。目的。评估在急诊科启动PCA的急诊就诊比例。方法。对连续的SCD疼痛急诊就诊病例进行了为期两年的回顾性病历审查。提取的数据包括PCA启动情况、低使用率与高使用率状态、疼痛评分、阿片类药物推注次数、治疗时间和住院时长。结果。258次就诊导致住院。在230次（89%）就诊中启动了PCA，其中157次（68%）在急诊科启动。与在急诊科启动PCA相比，住院后启动PCA的时间更长（8.6小时对4.5小时，p < 0.001）。决定收治后，急诊科启动PCA与较少的阿片类药物推注次数以及较短的无镇痛治疗时间相关（所有p < 0.05）。两组间平均疼痛强度（MPI）降低情况无差异。在急诊科启动PCA的就诊中，低使用率患者的MPI降低幅度高于高使用率患者（2.8对2.0，p = 0.04）。结论。对于与SCD相关的疼痛，在急诊科启动PCA是可行的，且与更及时的镇痛给药相关。
