Treatment of uncomplicated vaso‐occlusive crises in children with sickle cell disease in a day hospital

Raphael, Jean L.; Kamdar, Aditi; Beavers, M. Brooke; Mahoney, Donald H.; Mueller, Brigitta U.

doi:10.1002/pbc.21483

Cited by 34 publications

(24 citation statements)

References 18 publications

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“…During their first five years of operation, they, too, were able to discharge more than 80% of the patients to home, compared to the emergency department’s 94% hospital admission rate 90. Similar findings have been reported in the UK,91 in Jamaica,92 and for pediatric patients 93. Unfortunately, there are few such facilities in the U.S.…”

Section: Scd Pain and Symptom Managementsupporting

confidence: 85%

Sickle Cell Disease: An Opportunity for Palliative Care Across the Life Span

Wilkie

Johnson²,

Mack

et al. 2010

Nursing Clinics of North America

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Sickle cell disease is a chronic illness that impacts patients physically and emotionally and can do so at an early age. An ecological model of palliative care that involves improved communication among the health care team, patients, and their families can be beneficial. Open and honest communication regarding advance care planning, disease management, relief of pain and other symptoms, and bereavement and grief are all important for the patient, family, and health care team. Given the multiple acute and chronic complications of sickle cell disease, an approach to care that is holistic and comprehensive may help to improve a patient's biological function and the perceived health, functional status, and quality of life of the patient and family.

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Section: Scd Pain and Symptom Managementsupporting

confidence: 85%

Sickle Cell Disease: An Opportunity for Palliative Care Across the Life Span

Wilkie

Johnson²,

Mack

et al. 2010

Nursing Clinics of North America

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“…10 The proportion of patients hospitalized for pain was substantially lower in those taking hydroxyurea than those taking placebo; there was no difference in their length of stay, which was approximately 4 days and similar to other reports. [11][12][13] In the hydroxyurea group, none of the baseline parameters was associated with the occurrence of multiple pain events, perhaps because there were so few children in the hydroxyurea group with multiple pain events. Subjects who were asymptomatic at study enrollment had lower rates of dactylitis, as well as fewer transfusions and hospitalizations (Table 4).…”

Section: Discussionmentioning

confidence: 99%

Impact of hydroxyurea on clinical events in the BABY HUG trial

Thornburg

Files

Luo

et al. 2012

Blood

229

185

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The Pediatric Hydroxyurea Phase 3 Clinical Trial (BABY HUG) was a phase 3 multicenter, randomized, double-blind, placebocontrolled clinical trial of hydroxyurea in infants (beginning at 9-18 months of age) with sickle cell anemia. An important secondary objective of this study was to compare clinical events between the hydroxyurea and placebo groups. One hundred and ninetythree subjects were randomized to hy- Continuing Medical Education onlineThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™ . Physicians should claim only the credit commensurate with the extent of their participationin the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see page 4448. Disclosures The authors, the Associate Editor Narla Mohandas, and CME questions author Laurie Barclay, freelance writer and reviewer, Medscape, LLC, declare no competing financial interests. Learning objectivesUpon completion of this activity, participants will be able to:1. Describe the effect of hydroxyurea on rates of sickle cell complications for infants with sickle cell anemia (SCA) on the basis of a phase 3, multicenter, randomized trial.2. Describe the effect of hydroxyurea on rates of hospitalizations and transfusions for infants with SCA on the basis of a phase 3, multicenter, randomized trial.3. Describe the safety of hydroxyurea for infants with SCA on the basis of a phase 3, multicenter, randomized trial.

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“…Parenteral opioids given on a time-contingent basis, often in combination with parenteral NSAIDs, is the most common pharmacologic therapy in this situation, but few large controlled trials are available to guide dosing. Frequent dose titration to adequate pain relief in specialized day hospital units has been quite effective in children [423], as it has been in adults, but has been difficult to apply to more traditional emergency department settings. Continuation of parental opioids and NSAIDs after admission is common practice, often using patient-controlled analgesia systems in older children and adolescents [406], but large randomized studies are not available to provide an evidence base for practice.…”

Section: Pediatric Pain Syndromes: Pathophysiology Assessment Anmentioning

confidence: 99%

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

Ballas

Kesen

Goldberg

et al. 2012

The Scientific World Journal

158

144

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The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes.

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Treatment of uncomplicated vaso‐occlusive crises in children with sickle cell disease in a day hospital

Abstract: We conclude that a dedicated Day Hospital facility has the potential to provide patient-centered, effective, and timely management of vaso-occlusive crises in children as well as adults.

Cited by 34 publications

References 18 publications

Sickle Cell Disease: An Opportunity for Palliative Care Across the Life Span

Sickle Cell Disease: An Opportunity for Palliative Care Across the Life Span

Impact of hydroxyurea on clinical events in the BABY HUG trial

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

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