Normal saline bolus use in pediatric emergency departments is associated with poorer pain control in children with sickle cell anemia and vaso-occlusive pain
Normal saline bolus use in pediatric emergency departments is associated with poorer pain control in children with sickle cell anemia and vaso-occlusive pain
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DOI：
10.1002/ajh.25471
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发表时间：
2019-06-01
影响因子：
12.8
通讯作者：
Morris, Claudia R.
中科院分区：
文献类型：
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作者：
Carden, Marcus A.;Brousseau, David C.;Morris, Claudia R.
血管闭塞性疼痛事件 (VOE) 是镰状细胞性贫血 (SCA) 急诊科 (ED) 就诊的主要原因。本研究评估了静脉输液 (IVF) 使用的变异性以及生理盐水推注 (NSB) 与 SCA 儿童疼痛和其他临床结果的关系，并向儿科急诊科 (PED) 提出了 VOE。一项回顾性研究对 400 名 3-21 岁 SCA/VOE 儿童接受肠外阿片类药物、20 次大容量 PED 的图表进行了评估。收集了有关体外受精类型和数量的数据。患者被分为两组：接受 NSB 治疗的组和未接受 NSB 治疗的组。评估了 NSB 使用与疼痛评分变化和入院率之间的关系。在接受研究的 400 名儿童中，261 名 (65%) 获得了 NSB。平均年龄为 13.8 +/- 4.9 岁； 46%为男性； 92% 的人有血红蛋白-SS。 84% 的患者使用了 IVF（推注和/或维持）。使用了八种不同类型的体外受精，并且体外受精的剂量差异很大。各组之间的平均分诊疼痛评分相似，但 NSB 组从就诊到急诊处理的疼痛评分改善较小（2.2 vs 3.0，P = .03），而入院率较高（71% vs 59%，P = .01）。在我们的多变量模型中，NSB 的使用仍然与较差的最终疼痛评分和较差的疼痛评分变化相关。总之，体外受精实践中的广泛差异是很常见的。 NSB 用于 > 50% 的 SCA/VOE 儿童，但与疼痛控制较差有关；需要进行对照前瞻性试验来确定因果关系。
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.