Sickle Cell Crisis
Conditions
Brief summary
Sickle cell disease (SCD) is an inherited blood disorder affecting approximately 36,000 children in the United States, approximately 90% of whom are Black. The disease is characterized by recurrent, severe pain crises which result in high rates of emergency department visits and hospitalizations, and decreased quality of life. The National Heart, Lung and Blood Institute, as well as the American Society of Hematology, have endorsed pain management guidelines regarding the timeliness of care for children presenting with these acute pain crises. These evidence-based guidelines are infrequently followed, resulting in increased pain and hospitalizations. In additional to other barriers to following the guideline, structural racism has been proposed as a significant contributor and the New England Journal of Medicine recently called for the institution of SCD-specific pain management protocols to combat structural racism and reduce time to opioid administration. The investigators' long-term goal is to improve the care and health outcomes of children with acute painful vaso-occlusive crisis treated in the emergency department. The overall aim of the investigators is to test a care pathway using multifaceted implementation strategies to increase guideline adherent care for children in the emergency department with acute painful vaso-occlusive crisis.
Interventions
OTHERCare pathway
Implementation of care pathway as part of hybrid type 2 implementation effectiveness study
Sponsors
Pediatric Emergency Care Applied Research Network
Nemours Children's Health System
Medical College of Wisconsin
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
* ED visit for uncomplicated pain crisis * Sickle cell disease * Receipt of at least one opioid
Exclusion criteria
* Acute chest syndrome * Fever \> 38.5 in the ED * priapism * sickle cell trait
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Timeliness of receipt of opioids | A maximum of about 6 hours as all opioids received during the ED stay will be captured | The percent of patients who receive first dose of opioids within 60 minutes of arrival and subsequent doses within 30 minutes of previous dose |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Median time to opioids | A maximum of about 6 hours as all opioids received during the ED stay will be captured | Median time from arrival to first opioid and then subsequent opioids |
| Percent of children hospitalized | A maximum of about 6 hours as that is the typical maximum time to disposition for patients | Disposition of hospitalization or discharge home |
Countries
United States
Contacts
Primary ContactDavid Brousseau, MD, MS
Outcome results
None listed