Time to pain relief: A randomized controlled trial in the emergency department during vaso-occlusive episodes in sickle cell disease

Link to article at PubMed

Eur J Haematol. 2023 Jan 5. doi: 10.1111/ejh.13924. Online ahead of print.


OBJECTIVE: Compare time to pain relief (minimum of a 13 mm and 30% reduction) during an Emergency Department (ED) visit among patients with sickle cell disease (SCD) experiencing severe pain associated with a vaso-occlusive episode who were randomized to receive either an individualized or weight-based pain protocol.

METHODS: A randomized controlled trial in two EDs. Adults with sickle cell disease. Research staff recorded pain scores every 30 minutes during an ED visit (up to six hours in the ED) using a 0-100 mm visual analogue scale. Analysis included 122 visits, representing 49 patients (Individualized: 61 visits, 25 patients; standard: 61 visits, 24 patients).

RESULTS: Pain reduction across 6-hours was greater for the individualized compared to the standard protocol (protocol-by-time: p=0.02; 6-hour adjusted pain score comparison: Individualized: M=29.2, SD=38.8, Standard: M=45.3, SD=35.6; p=0.03, Cohen d=0.43). Hazards models indicated a greater probability of 13 mm (HR=1.54, 95% CI=1.05, 2.27, p=0.03) and 30% (HR=1.71, 95% CI=1.11, 2.63, p=0.01) reduction in the individualized relative to the standard protocol.

CONCLUSIONS: Patients who received treatment with an individualized protocol experienced a more rapid reduction in pain, including a 13 mm and 30% reduction in pain scores when compared to those that received weight-based dosing. This article is protected by copyright. All rights reserved.

PMID:36602417 | DOI:10.1111/ejh.13924

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