Radwi Mansoor, Jamal Wisam, Aljubayri Abrar A, Hassan Abdulrahman S, Alamri Haitham S, Alraddadi Osama A, Alghamdi Saeed, Alashari Abdualrahman T, Rizk Hisham A
Medicine, University of Jeddah, Jeddah, SAU.
General Surgery, Faculty of Medicine, University of Jeddah, Jeddah, SAU.
Cureus. 2024 Sep 12;16(9):e69268. doi: 10.7759/cureus.69268. eCollection 2024 Sep.
Introduction Sickle cell anemia (SCA) affects the Saudi Arabian population significantly, with 4.2% carriers and 0.26% affected. Vaso-occlusive crises cause severe pain due to blood vessel blockage by sickled cells, leading to frequent emergency visits, where treatment includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs), oxygen, and opioids. This study examines opioid use in managing SCA crises in Saudi emergency departments. Method A retrospective cross-sectional study in western Saudi Arabia surveyed board-certified emergency physicians (consultants, fellows, specialists) via the Sickle Cell Disease Implementation Consortium (SCDIC). Non-board-certified physicians and general practitioners were excluded. Data were gathered through structured surveys and supplemented by interviews. Results The study included 53 emergency physicians, mostly specialists (60.4%), with one to three years' experience, primarily from King Abdul Aziz University Hospital (28.3%) and King Abdullah Medical Complex (22.6%). While more than half of the participants felt adequately trained for SCA management, 20.8% faced challenges referring patients to case management programs. Major barriers included department overcrowding and the opioid epidemic. Conclusion The study reveals challenges in managing SCA in Saudi emergency departments, particularly with opioid use. Despite physician training, gaps in administrative support, medication access, and follow-up care persist. Institutional policies and opioid epidemic concerns restrict Schedule-II opioid prescriptions. Implementing a comprehensive opioid administration tracking system and standardizing protocols are crucial for enhancing patient outcomes. Future efforts should focus on improving resources and inter-institutional collaboration.
引言
镰状细胞贫血（SCA）对沙特阿拉伯人口影响显著，携带者占4.2%，患者占0.26%。血管闭塞性危机会因镰状细胞阻塞血管而导致剧痛，致使患者频繁急诊，治疗包括使用非甾体抗炎药（NSAIDs）、氧气和阿片类药物。本研究调查了沙特急诊科在管理SCA危机中阿片类药物的使用情况。
方法
在沙特阿拉伯西部进行的一项回顾性横断面研究，通过镰状细胞病实施联盟（SCDIC）对获得董事会认证的急诊医生（顾问、研究员、专家）进行了调查。未获得董事会认证的医生和全科医生被排除在外。数据通过结构化调查收集，并辅以访谈。
结果
该研究纳入了53名急诊医生，大多数是专家（60.4%），有1至3年工作经验，主要来自阿卜杜勒阿齐兹国王大学医院（28.3%）和阿卜杜拉国王医疗中心（22.6%）。虽然超过一半的参与者认为自己在SCA管理方面接受了充分培训，但20.8%的人在将患者转诊至病例管理项目时面临挑战。主要障碍包括科室拥挤和阿片类药物流行。
结论
该研究揭示了沙特急诊科在管理SCA方面存在的挑战，尤其是在阿片类药物使用方面。尽管医生接受了培训，但在行政支持、药物获取和后续护理方面仍存在差距。机构政策和对阿片类药物流行的担忧限制了二类阿片类药物的处方。实施全面的阿片类药物给药跟踪系统并规范协议对于改善患者结局至关重要。未来的努力应集中在改善资源和机构间合作上。
