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<< Sickle Cell Disease And Other Hemoglobinopathies: Approaches To Emergency Diagnosis And Treatment

State Of The Literature

A recent review regarding the research on pain management in SCD suggests that the literature is weak. The authors note that most studies lack sufficient power to reflect treatment differences.21

The decision to order diagnostic studies in the patient with SCA is based more on tradition than on empiric data. Investigations regarding the association between hematologic parameters (such as the WBC count) and the need for admission are often flawed, as the physician is usually not blinded to the WBC count when deciding on admission. Thus, a high WBC count becomes a criterion for admission only because high WBC counts may worry some physicians (despite the lack of scientific correlation between outcome and these laboratory studies).

There are a number of published guidelines describing the management of patients with SCD, only a few of which are applicable to emergency medicine. One prominent guideline, published in 1999, is from the American Pain Society.22

In a survey of 550 emergency physician members of the Society for Academic Emergency Medicine, the authors found wide disparities in the approach to the patient with a painful sickle crisis.23 Twenty percent used protocols for management of sickle cell pain. Meperidine and morphine (either IM or IV) were the most common initial analgesics given. In the routine management of uncomplicated sickle cell painful crisis, IV analgesics were employed by 67% of the emergency medicine physicians, IV hydration by 71%, oxygen therapy by 66%, and CBCs by 82% of respondents. About 30% "always or often" ordered a urinalysis, and about 20% routinely ordered a chest x- ray. Most emergency physicians practicing in teaching hospitals said they rarely or never treat patients with hemolytic, aplastic, or sequestration crises.

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Last Modified: 07/23/2017
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