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Background Pain is the main source of distress in patients with sickle cell disease (SCD). Unmanageable pain, often termed ‘crises’, may prompt unexpected visits to the emergency department (ED) or other acute healthcare facilities. One study from the Eastern Province in Saudi Arabia reported that 64% of patients with SCD present to the ED more than three times over a 6-month period. Outpatient follow-up may have a role in preventing ED visits, but this has not been fully explored in Saudi Arabia. This study aimed to assess the relation between outpatient follow-up and future ED visits due to painful crises in patients with SCD. Methods This retrospective, observational study utilized data from the electronic medical record system at King Abdulaziz Medical City, National Guard Health Affairs in Riyadh. The study included adult patients with SCD who presented at least once to the ED due to a painful crisis between January 2016 and December 2017. The time between ED visits due to painful crises was set as the outcome variable. Cox regression analysis with random effects model (frailty model) was used to determine the effect of outpatient follow-up at 15 days, 30 days, and 90 days on the time to next ED visit. Baseline characteristics and previous history of sickle cell complication were included in the model as confounders. Results Eighty patients with SCD presented a total of 463 times to the ED due to painful crises. 54% of these visits required admission and resulted in a total length of stay of 1474 hospital days and 49 ICU days. Attendance at a hematology outpatient clinic within 30 days from discharge significantly reduced the hazard of an ED visit due to a painful crisis compared with no follow-up (hazard ratio 0.70, 95% CI 0.52–0.94, p=0.02). Conclusion Appropriate outpatient referral at discharge may be associated with decreased ED visits. These benchmark results invite further investigation into the effects of outpatient management on preventing painful crises in patients with SCD. |
