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Disposition For Vaso-Occlusive Crisis

There are no rigid guidelines regarding which patients with simple VOC should be admitted. The standard practice in many EDs is to give the patient 3 doses of IV opiates followed by admission if additional
analgesia is required. This practice of limiting the number of opiate doses a patient can receive without being admitted is often used to discourage patients from casually visiting the ED to receive IV opiates. There is indirect evidence that a more lenient approach may reduce hospital admissions and return visits to the ED. Between 1989 and 1993, the Bronx (New York) Comprehensive Sickle Cell Center at the Montefiore Medical Center operated an acute-care day hospital dedicated to treating SCD patients with simple VOC. Implementing a standardized, aggressive, opiate-based treatment protocol dramatically
reduced hospital admissions and recidivism.68 Although certain features of the day hospital can never be replicated in the ED, a policy of aggressive pain control without reflexively admitting after 3 doses of IV opiates is possible and may lead to fewer admissions and return visits to the ED. The author recommends that the patient with VOC be involved in the decision to admit and only those patients whose pain is refractory to IV hydration and aggressive pain control should be admitted to the hospital.

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Last Modified: 07/23/2017
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