Normal saline bolus use in pediatric emergency departments is associated with poorer pain control in children with sickle cell anemia and vaso‐occlusive pain
| Autor: | Amanda Bogie, Hartmut Grasemann, Robert W. Hickey, Angela M. Ellison, Claudia R. Morris, Sara Leibovich, Lewis L. Hsu, David C. Brousseau, Seema Bhatt, Syana Sarnaik, Daniel M. Cohen, Elizabeth C. Powell, Corrie E. Chumpitazi, Rachel Richards, Theron Charles Casper, Kathleen M. Brown, Carlton Dampier, Jonathan E. Bennett, Laura Chapman, Fahd A. Ahmad, Debra L. Weiner, Marcus A. Carden |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Pediatric emergency medicine.medical_specialty Adolescent medicine.medical_treatment Pain Anemia Sickle Cell Article 03 medical and health sciences 0302 clinical medicine Bolus (medicine) Pain control Internal medicine medicine Humans Pain Management Vascular Diseases Child Saline Retrospective Studies business.industry Retrospective cohort study Hematology Emergency department medicine.disease Triage Sickle cell anemia Child Preschool 030220 oncology & carcinogenesis Female Saline Solution Emergency Service Hospital business 030215 immunology |
| Zdroj: | Am J Hematol |
| ISSN: | 1096-8652 0361-8609 |
| Popis: | Vaso-occlusive pain events (VOE) are the leading cause of emergency department (ED) visits in sickle cell anemia (SCA). This study assessed the variability in use of intravenous fluids (IVFs), and the association of normal saline bolus (NSB), on pain and other clinical outcomes in children with SCA, presenting to pediatric emergency departments (PED) with VOE. Four-hundred charts of children age 3-21 years with SCA/VOE receiving parenteral opioids at 20 high-volume PEDs were evaluated in a retrospective study. Data on type and amount of IVFs used were collected. Patients were divided into two groups: those who received NSB and those who did not. The association of NSB use on change in pain scores and admission rates was evaluated. Among 400 children studied, 261 (65%) received a NSB. Mean age was 13.8 ± 4.9 years; 46% were male; 92% had hemoglobin-SS. The IVFs (bolus and/or maintenance) were used in 84% of patients. Eight different types of IVFs were utilized and IVF volume administered varied widely. Mean triage pain scores were similar between groups, but improvement in pain scores from presentation-to-ED-disposition was smaller in the NSB group (2.2 vs 3.0, P = .03), while admission rates were higher (71% vs 59%, P = .01). Use of NSB remained associated with poorer final pain scores and worse change in pain scores in our multivariable model. In conclusion, wide variations in practice utilizing IVFs are common. NSB is given to >50% of children with SCA/VOE, but is associated with poorer pain control; a controlled prospective trial is needed to determine causality. |
| Databáze: | OpenAIRE |
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