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

Publication ,  Journal Article
Tanabe, P; Silva, S; Bosworth, HB; Crawford, R; Paice, JA; Richardson, LD; Miller, CN; Glassberg, J
Published in: Am J Hematol
February 2018

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.

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Published In

Am J Hematol

DOI

EISSN

1096-8652

Publication Date

February 2018

Volume

93

Issue

2

Start / End Page

159 / 168

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Pain Measurement
  • Pain
  • Male
  • Immunology
  • Humans
  • Hospitalization
  • Female
  • Clinical Protocols
 

Citation

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Tanabe, P., Silva, S., Bosworth, H. B., Crawford, R., Paice, J. A., Richardson, L. D., … Glassberg, J. (2018). A randomized controlled trial comparing two vaso-occlusive episode (VOE) protocols in sickle cell disease (SCD). Am J Hematol, 93(2), 159–168. https://doi.org/10.1002/ajh.24948
Tanabe, Paula, Susan Silva, Hayden B. Bosworth, Regina Crawford, Judith A. Paice, Lynne D. Richardson, Christopher N. Miller, and Jeffrey Glassberg. “A randomized controlled trial comparing two vaso-occlusive episode (VOE) protocols in sickle cell disease (SCD).Am J Hematol 93, no. 2 (February 2018): 159–68. https://doi.org/10.1002/ajh.24948.
Tanabe P, Silva S, Bosworth HB, Crawford R, Paice JA, Richardson LD, et al. A randomized controlled trial comparing two vaso-occlusive episode (VOE) protocols in sickle cell disease (SCD). Am J Hematol. 2018 Feb;93(2):159–68.
Tanabe, Paula, et al. “A randomized controlled trial comparing two vaso-occlusive episode (VOE) protocols in sickle cell disease (SCD).Am J Hematol, vol. 93, no. 2, Feb. 2018, pp. 159–68. Pubmed, doi:10.1002/ajh.24948.
Tanabe P, Silva S, Bosworth HB, Crawford R, Paice JA, Richardson LD, Miller CN, Glassberg J. A randomized controlled trial comparing two vaso-occlusive episode (VOE) protocols in sickle cell disease (SCD). Am J Hematol. 2018 Feb;93(2):159–168.
Journal cover image

Published In

Am J Hematol

DOI

EISSN

1096-8652

Publication Date

February 2018

Volume

93

Issue

2

Start / End Page

159 / 168

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Pain Measurement
  • Pain
  • Male
  • Immunology
  • Humans
  • Hospitalization
  • Female
  • Clinical Protocols