Association of Hospital and Provider Types on Sickle Cell Disease Outcomes

Jan, Sophie; Slap, Gail B.; Smith‐Whitley, Kim; Dai, Dingwei; Rubin, David M.

doi:10.1542/peds.2013-0089

Cited by 25 publications

(19 citation statements)

References 35 publications

(38 reference statements)

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“…Although multiple studies using administrative databases have used ICD-9-CM codes for SCD, [17][18][19][20] there are currently no identifiable studies that have validated their accuracy. Second, we were limited in our ability to examine the effect of clinical variables referenced within the NHLBI recommendations, such as general appearance, results of laboratory data, and height of fever on admission rates.…”

Section: Limitationsmentioning

confidence: 99%

Variation in Pediatric Emergency Department Care of Sickle Cell Disease and Fever

Ellison

Thurm

Alessandrini

et al. 2015

Academic Emergency Medicine

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Objectives: The objective was to study the variation in pediatric emergency department (PED) practice patterns for evaluation and management of children with sickle cell disease (SCD) and fever in U.S. children's hospitals. Methods:A cross-sectional study of visits by children 3 months to 18 years of age with SCD and fever evaluated in 36 U.S. children's hospital PEDs within the 2010 Pediatric Health Information System database. The main outcome measures were the proportions of SCD visits that received evaluation (laboratory testing and chest radiographs [CXRs]) and treatment (parenteral administration of antibiotics) and were admitted for fever.Results: Of the 4,853 PED visits for SCD and fever, 91.7% had complete blood counts (CBCs), 93.8% had reticulocyte counts, 93% had blood cultures obtained, 68.5% had CXRs, and 91.7% received antibiotics. Most (81.4%) patients received the recommended National Heart, Lung and Blood Institute evaluation (CBC, reticulocyte count, and blood culture) and treatment (parenteral antibiotics). In multivariate regression modeling controlling for hospital-and patient-level effects, age groups ≥1 to <5 years (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.25 to 0.40) and ≥5 to <13 years (OR = 0.40, 95% CI = 0.32 to 0.50), and those visits that did not have CXRs had lower odds of hospital admission. After adjusting for age, payor status, receipt of laboratory testing, antibiotics, and CXRs, admission rates varied by sevenfold across U.S. children's hospitals (p < 0.001).Conclusions: Standardization of practice exists across children's hospitals regarding obtaining laboratory studies and administering antibiotics for patients with SCD and fever. However, admission rates vary significantly. Evaluating the causes and consequences of such significant variation needs further exploration to improve the quality of care for patients with SCD.ACADEMIC EMERGENCY MEDICINE 2015;22:423-430

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Section: Limitationsmentioning

confidence: 99%

Variation in Pediatric Emergency Department Care of Sickle Cell Disease and Fever

Ellison

Thurm

Alessandrini

et al. 2015

Academic Emergency Medicine

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“…Une étude pédiatrique a en effet retrouvé un taux de ventilation méca-nique supérieur dans les centres non spécialisés [6].…”

Section: éPidémiologieunclassified

Le syndrome thoracique aigu : complication pulmonaire aiguë des patients adultes atteints d’un syndrome drépanocytaire majeur

Maître¹,

Habibi²,

Colin³

et al. 2015

Réanimation

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Le syndrome thoracique aigu (STA) est une des complications majeures des syndromes drépanocytaires et reste la principale cause de mortalité chez l'adulte. Il peut survenir chez des patients auparavant peu ou non symptomatiques, notamment chez ceux porteurs d'un syndrome drépa-nocytaire composite. Trois grandes causes dominent les étio-logies : les infections, l'obstruction vasculaire pulmonaire (par des emboles graisseux et/ou des thrombi fibrinocruoriques) et les hypoventilations alvéolaires secondaires à des suites chirurgicales ou des infarctus osseux. La symptomatologie associe fièvre, dyspnée et douleur thoracique. Elle survient souvent après quelques jours d'hospitalisation pour crise vaso-occlusive simple ou en postopératoire. L'imagerie retrouve des lésions alvéolaires condensantes des deux bases pulmonaires et la biologie une hémolyse associée à un syndrome inflammatoire. Il faut savoir rechercher deux facteurs de mauvais pronostic : un taux de plaquettes bas et surtout une insuffisance ventriculaire droite.Le traitement repose sur un trépied : hydratation, oxygé-nation et analgésie associés à une antibiothérapie couvrant les bactéries encapsulées et atypiques. Dans les formes sévè-res, le seul traitement spécifique est la transfusion ou l'exsanguinotransfusion suivant le taux d'hémoglobine. Une transfusion préventive ou un échange transfusionnel peuvent être discutés chez des patients à risque, notamment lors de circonstances particulières (grossesse, intervention chirurgicale). Cette décision sera prise au cas par cas en fonction des antécédents transfusionnels. Dans le cadre de la prévention, une spirométrie incitative doit toujours être prescrite pour les patients drépanocytaires hospitalisés, notamment pour crise vaso-occlusive. Mots clés Drépanocytose · Syndrome thoracique aigu · RéanimationAbstract Acute chest syndrome is the second most common reason for hospitalization and the leading cause for mortality in adult patients with sickle cell disease. This complication is not only observed in most severe patients, but can appear in previously non symptomatic patients. Three main mechanisms are involved: infection, vascular obstruction (by fat embolism and/or pulmonary artery thrombus), and alveolar hypoventilation secondary to surgery or to bone infarcts. The most frequent symptoms are fever, dyspnea, and thoracic pain. In half of patients, vaso-occlusive crisis can precede these symptoms. Basal alveolar consolidation is observed on lung imaging. Hemolysis and systemic inflammation are frequent biological findings. Two prognostic markers have been suggested in the litterature: thrombopenia and right ventricular dysfunction. Supportive treatments (oxygenation, rehydration, and analgesia) are usually prescribed with antibiotics. Transfusion and/or partial blood exchange depending on the haemoglobin level are used in the severe forms. Preventive transfusion should be discussed in specific conditions such as pregnancy and surgical procedure. Preventive incentive spirometry should also be implemented in...

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“…In 27]. However, and similarly to the management of all ARDS, a protective ventilatory strategy to avoid or limit the deleterious effects of ventilation on the right ventricle is even more critical in SCD patients, because of the high prevalence of pulmonary vascular dysfunction during severe ACS [28].…”

Section: Respiratory Supportmentioning

confidence: 99%