Multi-modal intervention for the inpatient management of sickle cell pain significantly decreases the rate of acute chest syndrome.
Multi-modal intervention for the inpatient management of sickle cell pain significantly decreases the rate of acute chest syndrome.
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DOI：
10.1002/pbc.22808
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发表时间：
2011-02
影响因子：
3.2
通讯作者：
Frei-Jones, Melissa J.
中科院分区：
文献类型：
--
作者：
Reagan, Mary M.;DeBaun, Michael R.;Frei-Jones, Melissa J.
Pain in children with sickle cell disease (SCD) is the leading cause of acute care visits and hospitalizations. Pain episodes are a risk factor for the development of acute chest syndrome (ACS), contributing to morbidity and mortality in SCD. Few strategies exist to prevent this complication. We performed a before-and-after prospective multi-modal intervention. All children with SCD admitted for pain during the two-year study period were eligible. The multi-modal intervention included standardized admission orders, monthly house staff education, and one-on-one patient and caregiver education. A total of 332 admissions for pain occurred during the study period; 159 before the intervention and 173 during the intervention. The ACS rate declined by 50% during the intervention period 25%, (39 of 159) to 12%, (21 of 173); p=0.003. Time to ACS development increased from 0.8 days (0.03–5.2) to 1.7 days (0.03–5.8); p=0.047. No significant difference was found in patient demographics, intravenous fluid amount administered, frequency of normal saline bolus administration, or cumulative opioid amount delivered in the first 24-hours. Patient controlled analgesia (PCA)-use was more common after the intervention 52%, (82 of 159) vs 73%, (126 of 173; p=0.0001) and fewer patients required changes in analgesic dosing within the first 24-hours after admission (26%, 42 of 159 vs 16%, 28 of 173; p=0.015). A multi-modal intervention to educate and subsequently change physician behavior likely decreased the rate of ACS in the setting of a single teaching hospital.
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