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A Five Fold Decrease in Admissions for Uncomplicated Vaso-Occlusive Crisis and Other Benefits from Care in Infusion Clinics: Results from the Escaped Trial

key information

source: American Society of Hematology

year: 2018

authors: Sophie Lanzkron, Jane Little, Joshua J. Field, Carlton Haywood Jr., Ravi Varadhan, Mustapha Saheed, Marc Proudford, Derek Robertson, Adrienne Kincaid, Lorri Burgess, Charles Green, Hang Wang, Rebecca Seufert, Jasmine Brooks, Allie Piehet, Brandi Griffin, Nicole Arnold, Steven Frymark, Chiung- Yu Huang, Marcus Wallace, Nebras Abu Al Hamayel, Jodi Segal

summary/abstract:

Patients with sickle cell disease (SCD) suffer from frequent vaso-occlusive crises (VOC), the leading cause of hospitalization and ED visits for these patients. Infusion centers (IC) are alternatives to ED care and may provide patients with a better care experience. We previously demonstrated in a single center that the use of such centers provides more rapid pain control and can decrease the risk of a hospital admission. For the management of VOC the NHLBI’s guidelines recommend that patients receive analgesic therapy within 60 minutes of registration and that pain be reassessed every 15-30 minutes until it is controlled. In the ESCAPED study, we aimed to learn whether the ED or IC more rapidly provides analgesia to patients who present with an uncomplicated VOC.

Conclusions: With adjustment for differences between patients treated in the ED and IC, we demonstrated that those treated in an IC have significantly better treatment experiences than subjects treated in an ED: a 50% reduction in time to first dose of pain medication and an almost 6-fold decrease in hospital admission. Increasing access to infusion clinics is essential to improving the quality of care of uncomplicated VOC in adults with SCD.

organization: Johns Hopkins University School of Medicine, USA; Cwru/University Hospitals, USA; Case Western Reserve University/ University Hospitals Seidman Cancer Center, USA; Medical College of Wisconsin, USA; The Johns Hopkins University, USA; Johns Hopkins Community Based Orginization Partner, USA; Maryland Sickle Cell Disease Association, USA; Kincaid's Kindred Spirits Community Based Organization Partner, USA; Community Based Organization Partner, Lady of the Lake Regional Medical Center, USA; Community Based Organization Partner, Blood Center of Wisconsin, USA; Johns Hopkins School of Medicine, USA; Our Lady of the Lake Hospital, USA; Case Western Reserve University Hospital, USA; Case Western Reserve University Hospital, USA; Blood Center of Wisconsin, USA; University of California San Francisco, USA; Louisiana Health Care Connection, USA; Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins School of Medicine, USA

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