Predictors of morphine and hydromorphone doses for patients with sickle cell disease in an urban day hospital and emergency department | oneSCDvoice
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Predictors of morphine and hydromorphone doses for patients with sickle cell disease in an urban day hospital and emergency department

key information

source: The Journal of Pain

year: 2013

authors: R. Molokie, M. Suarez, M. Ezenwa, Y. Yao, Z. Zhao, Z. Wang, D. Wilkie

summary/abstract:

Day hospitals (DH) decreased the number of patients admitted to the hospital for treatment of painful episodes in sickle cell disease (SCD) compared to emergency departments (ED). Reasons for differences in DH and ED admission rates are unclear. We determined the predictors of hospital admission rates for adults with acute vaso-occlusive pain when presenting to the DH and ED. We extracted medical record data for 148 subjects (35% male; mean age 34±12 yr; 99% African American; 74% SS, 14% SC, 12% other genotype) admitted to the ED (n=144) and/or DH (n=73).

We abstracted from medical records the DH/ED admission pain intensity (AD-Pain), first opioid drug and dose, total opioid drug and dose, Toradol dose, length of visit, and hospital admit rate. In the DH, 74% were given morphine first and 26% were given hydromophone first. In the ED, 67.4% were given morphine first, 27.8% were given hydromorphone first, 4.9% were not given either opioid.

We grouped DH and ED visits into: (1) below standard: <.05mg/kg/2hr morphine, .01 mg/kg/2hr hydromorphone (12% DH/33% ED); (2) standard: .05-.1 mg/kg/2hr morphine, .01-.015 mg/kg/2hr hydromorphone (23% DH/30% ED); (3) SCD dose: .1-.15 mg/kg/2hr morphine, .015-.025 mg/kg/2hr hydromorphone (27% DH/13% ED); and (4) > SCD dose: >.15 mg/kg/2hr morphine, >.025 mg/kg/2hr for hydromorphone (37% DH/24% ED). 33% of DH and 68% of ED visits resulted in hospital admits. Using mixed level analysis, we found: (1) the > SCD dose was associated with a high admit rate, (2) DH had lower admit rate, but the gap narrowed at high DH/ED AD-Pain levels, (3)Toradol lowered the admit rate but was less effective at high AD-Pain, and (4) males did better than females in ED, vice versa in DH. Findings provide insights about improving management of acute vaso-occlusive SCD pain.

organisation: University of Illinois, Chicago, IL

DOI: 10.1016/j.jpain.2013.01.689

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