Pain management of children and adolescents with sickle cell disease presenting to the emergency department

OBJECTIVE: To show and characterize our practice in the initial management of children and adolescents with sickle cell disease (SCD) presenting in acute painful crises, and to identify if there is a delay in patients getting the initial analgesics compared with standard guidelines.

METHODS: This retrospective cohort study was conducted at the Emergency Department (ED) of King Abdulaziz Hospital, Al-Ahsa, Kingdom of Saudi Arabia. The study participants were patients who visited the ED with acute painful crises related to SCD between July 2006 and July 2007. Exclusion criteria included age younger than 5 years and those older than 18 years old. A structured medical records review was used to abstract the data. The data was then computed using the Statistical Package for Social Sciences (SPSS, Chicago, IL, USA) for Windows version 16.

RESULTS: There were 270 patient visits made by 43 patients. The time to administration of initial analgesic drugs was 42.2±20.4 minutes. Two hundred thirty-seven (87.7%) visits were discharged from ED after an average length of stay of 183.9±129.3 minutes. The 3 most common initial analgesics used were morphine sulphate, voltaren, and paracetamol. The routes frequently used were intravenous, oral, and intramuscular.

CONCLUSION: There was a delay in the administration of the initial analgesic and approximately a fifth of patients received their analgesics via an unrecommended intramuscular route.