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

Abstract

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.

Positive impacts of universal newborn screening on the outcome of children with sickle cell disease in the province of Quebec: A retrospective cohort study

“…We illustrate the impact of the QcNS on disease severity by eval- rate [19,20]. However, such modifications are less likely to explain a decrease in emergency visits and may therefore likely reflect an impact of the use of preventive measures, such as the use of HU therapy at an earlier age.…”

“…While we have no doubts that early referral of children with inherited diseases such as SCD is key to improving disease outcomes, other factors may also have influenced such outcomes. Improvement in the management of VOC, as well as modification in protocols for febrile illness, may also have contributed to a reduction in hospitalization rate [ 19 , 20 ]. However, such modifications are less likely to explain a decrease in emergency visits and may therefore likely reflect an impact of the use of preventive measures, such as the use of HU therapy at an earlier age.…”