Hospital readmission for adult acute sickle cell painful episodes: Frequency, etiology, and prognostic significance
Hospital readmission for adult acute sickle cell painful episodes: Frequency, etiology, and prognostic significance
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DOI：
10.1002/ajh.20336
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发表时间：
2005-05-01
影响因子：
12.8
通讯作者：
Lusardi, M
中科院分区：
文献类型：
--
作者：
Ballas, SK;Lusardi, M
急性镰状细胞疼痛发作是镰状细胞贫血患者住院的最常见原因。其详细的临床特征和周围放电特征并不清楚。为了确定SS患者住院的实际模式和频繁再入院的原因及其预后意义，我们对1998年1月至2002年12月间入住托马斯杰斐逊大学医院的所有镰状细胞性贫血成人患者进行了前瞻性纵向观察队列研究。主要结果指标包括出院后1周和1个月内再入院的频率、病因和预后意义。还确定了研究期间患者的死亡率。数据分析显示，约50%的急性疼痛发作住院患者在出院后1个月内再次入院，约16%的住院患者在出院后1周内再次入院。疼痛强度评分在入院前4天显著下降（P < 0.001），然后达到平台期，直到出院。在整个住院期间，疼痛强度的平均评分> 7。再入院的原因包括提前出院、戒断综合征和新的急性发作复发。出院后1周内再次入院与死亡率较高相关。这项研究表明，镰状细胞性贫血的成年患者再入院是常见的。这表明，需要改善住院期间和出院后在家中的疼痛管理。出院后1周内频繁再入院的患者预后差，需要密切监测。Am.血液学杂志79：17-25，2005. (c)2005 Wiley-Liss，Inc.
The acute sickle cell painful episode is the most common cause of hospitalization of patients with sickle cell anemia. Its detailed clinical features and peri-discharge features are not well known. In order to determine the actual pattern of hospital admissions of patients with SS and the causes of frequent hospital readmissions and their prognostic significance, we conducted a prospective longitudinal and observation cohort study of all adult patients with sickle cell anemia admitted to Thomas Jefferson University Hospital between January 1998 and December 2002. Major outcome measures included the frequency, etiology, and prognostic significance of readmissions to the hospital within 1 week and 1 month after discharge. Incidence of mortality among patients during the study period was also determined. Analysis of the data showed that about 50% of hospital admissions for acute painful episodes were readmitted within 1 month after discharge, and about 16% of all admissions were within 1 week after discharge. The intensity of pain score decreased significantly during the first 4 days of hospital admission (P < 0.001) and then reached a plateau until discharge. The mean score of pain intensity was > 7 throughout the hospital stay. Causes of hospital readmission included premature discharge, withdrawal syndrome, and recurrence of new acute episodes. Readmission within 1 week after discharge was associated with higher mortality than otherwise. This study shows that hospital readmission of adult patients with sickle cell anemia is common. It suggests that improvement is needed in the management of pain during hospitalization and at home after discharge. Patients who are readmitted frequently within 1 week of discharge have poor prognosis and require careful monitoring. Am. J. Hematol. 79:17-25, 2005. (c) 2005 Wiley-Liss, Inc.