Molokie Robert E, Montminy Chariz, Dionisio Corissa, Farooqui Muhammad Ahmen, Gowhari Michel, Yao Yingwei, Suarez Marie L, Ezenwa Miriam O, Schlaeger Judith M, Wang Zaijie J, Wilkie Diana J
University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States; Jesse Brown Veterans Administration Medical Center, 820 S. Damen Avenue, MP 111, Chicago, IL 60612, United States; University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States.
University of Illinois Hospital and Health Sciences System, Department of Nursing, 1740 W. Taylor, Chicago, IL 60614, United States.
Am J Emerg Med. 2018 Jan;36(1):88-92. doi: 10.1016/j.ajem.2017.07.037. Epub 2017 Jul 13.
Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay.
In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay.
Pain on admission to the ED averaged 8.7±1.5 and to the ACU averaged 8.0±1.6. The average pain on discharge from the ED was 6.4±3.0 and for the ACU was 4.5±2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted.
Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions.
与急诊科相比，专注于镰状细胞病（SCD）护理的急性护理单元（ACU）已被证明能有效缓解疼痛并减少住院次数，但入院率差异的原因尚未得到充分研究。我们的目的是比较ACU和急诊科对成年SCD患者疼痛的常规护理在阿片类药物剂量、出院时疼痛评分、住院率和住院时间方面的效果。
在一项回顾性、比较队列、单学术三级中心研究中，148名患有镰状细胞疼痛的成年人在急诊科、ACU或两者接受了治疗。我们从医疗记录中记录了阿片类药物剂量、各单元出院时疼痛评分、住院率和住院时间。
急诊科入院时的平均疼痛评分为8.7±1.5，ACU入院时的平均疼痛评分为8.0±1.6。急诊科出院时的平均疼痛评分为6.4±3.0，ACU为4.5±2.5。144次急诊科就诊中有70%导致住院，而73次ACU就诊中有37%导致住院。急诊科或ACU的住院患者住院时间相似。注意到急诊科和ACU在首次阿片类药物剂量和每小时阿片类药物剂量方面存在显著差异。
与急诊科相比，在ACU中对成年SCD急性疼痛发作应用更高剂量阿片类药物的指南与改善疼痛结果和减少住院次数相关。在急诊科对SCD疼痛采用这种方法可能会改善结果，包括减少住院次数。
