A 19-year-old woman with sickle cell disease and pain

Ward, Richard A.; Simpson, Ewurabena; Verhovsek, Madeleine

doi:10.1503/cmaj.150512

CMAJ

2016

DOI: 10.1503/cmaj.150512

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A 19-year-old woman with sickle cell disease and pain

Richard A. Ward

Ewurabena Simpson

Madeleine Verhovsek

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2018

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“…Many treatment protocols (12)(13)(14)(15) are currently used for the treatment of VOC. The Canadian consensus statements (16,17) suggest a rapid evaluation of pain, to eliminate other associated symptoms and conditions, using a graded pain scale. Hydration should be instituted early, either orally or via intravenous (IV) line.…”

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confidence: 99%

Oral morphine protocol evaluation for the treatment of vaso-occlusive crisis in paediatric sickle cell patients

Paquin

Trottier

Robitaille

et al. 2018

Paediatrics &Amp; Child Health

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Background: Vaso-occlusive crisis (VOC) is one of the most frequent causes of emergency visit and admission in children with sickle cell disease (SCD).Objectives: This study aimed to evaluate whether the implementation of a protocol promoting the use of oral morphine as a primary intervention has led to improved care of SCD. Methods: We performed a retrospective chart review of patients with SCD who presented to the emergency department (ED) and hematology outpatient clinic (HOC) with VOC, in the year pre and postimplementation of the protocol. The primary outcome was the hospitalization rate. Results: The protocol resulted in a significant 43% reduction of hospitalization rate (95% confidence interval [CI] −53.0, 26.5). Results also showed a 35% increase in the use of oral morphine as first-line opiate treatment (95% CI 17.9, 45.2), a 28% increase in the use of pain scales (95% CI 17.3, 43.2) and a 30% net increase in patients eventually not requiring intravenous (IV) line placement (95% CI 16.0, 39.9). While we did observe an overall decrease in length of stay in ED of -55 min (95% CI −100.6, −12.0), there was a nonsignificant decrease of 7 minutes (95% CI −26, 3) in the opiate administration time. Conclusions: This study validates the use of our oral morphine protocol for the treatment of VOC by significantly reducing the admission rate and decreasing the number of IVs.

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mentioning

confidence: 99%

Oral morphine protocol evaluation for the treatment of vaso-occlusive crisis in paediatric sickle cell patients

Paquin

Trottier

Robitaille

et al. 2018

Paediatrics &Amp; Child Health

View full text Add to dashboard Cite

show abstract

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A 19-year-old woman with sickle cell disease and pain

Cited by 1 publication

References 10 publications

Oral morphine protocol evaluation for the treatment of vaso-occlusive crisis in paediatric sickle cell patients

Oral morphine protocol evaluation for the treatment of vaso-occlusive crisis in paediatric sickle cell patients

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