A randomized controlled trial comparing two vaso-occlusive episode (VOE) protocols in sickle cell disease (SCD).

Tanabe, Paula

Silva, Susan

Bosworth, Hayden B

Crawford, Regina

Paice, Judith A

Richardson, Lynne D

Miller, Christopher N

Glassberg, Jeffrey

2024-01-26T16:17:29Z

2024-01-26T16:17:29Z

2018-02

Limited evidence guides opioid dosing strategies for acute Sickle Cell (SCD) pain. We compared two National Heart, Lung and Blood (NHBLI) recommended opioid dosing strategies (weight-based vs. patient-specific) for ED treatment of acute vaso-occlusive episodes (VOE). A prospective randomized controlled trial (RCT) was conducted in two ED's. Adults ≥ 21 years of age with SCD disease were eligible. Among the 155 eligible patients, 106 consented and 52 had eligible visits. Patients were pre-enrolled in the outpatient setting and randomized to one of two opioid dosing strategies for a future ED visit. ED providers accessed protocols through the electronic medical record. Change in pain score (0-100 mm VAS) from arrival to ED disposition, as well as side effects were assessed. 52 patients (median age was 27 years, 42% were female, and 89% black) had one or more ED visits for a VOE (total of 126 ED study visits, up to 5 visits/patient were included). Participants randomized to the patient-specific protocol experienced a mean reduction in pain score that was 16.6 points greater than patients randomized to the weight-based group (mean difference 95% CI = 11.3 to 21.9, P = 0.03). Naloxone was not required for either protocol and nausea and/or vomiting was observed less often in the patient-specific protocol (25.8% vs 59.4%, P = 0.0001). The hospital admission rate for VOE was lower for patients in the patient-specific protocol (40.3% vs 57.8% P = 0.05). NHLBI guideline-based analgesia with patient-specific opioid dosing resulted in greater improvements in the pain experience compared to a weight-based strategy, without increased side effects.

0361-8609

1096-8652

https://hdl.handle.net/10161/29893

eng

Wiley

American journal of hematology

10.1002/ajh.24948

https://creativecommons.org/licenses/by-nc/4.0

Humans

Pain

Arterial Occlusive Diseases

Anemia, Sickle Cell

Analgesics, Opioid

Pain Measurement

Treatment Outcome

Clinical Protocols

Hospitalization

Adult

Female

Male

Young Adult

A randomized controlled trial comparing two vaso-occlusive episode (VOE) protocols in sickle cell disease (SCD).

Journal article

Bosworth, Hayden B|0000-0001-6188-9825

159

168

2

Duke

School of Medicine

School of Nursing

Faculty

Basic Science Departments

Clinical Science Departments

Institutes and Centers

Medicine

Psychiatry & Behavioral Sciences

Medicine, General Internal Medicine

Medicine, Hematology

Duke Cancer Institute

Duke Clinical Research Institute

Institutes and Provost's Academic Units

Psychiatry, Child & Family Mental Health & Community Psychiatry

Center for the Study of Aging and Human Development

Initiatives

Duke Science & Society

Population Health Sciences

Duke Innovation & Entrepreneurship

Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences

Emergency Medicine

Duke - Margolis Center For Health Policy

Published

93