Day-care management of sickle cell painful crisis in Jamaica: a model applicable elsewhere?

In the U.K. and the U.S.A., painful crises account for 80-90% of sickle-cel l-related hospital admissions, with average durations of 5-11 d. In Jamaica , many severe painful crises are managed in a day-care centre. Patients (n= 1160) with homozygous sickle cell (SS) disease aged 18 years and over were registered with the clinic during a 1-year study period. Of these, 216 pati ents with 476 painful crises attended the day-care facility for a total of 686 d. Most patients (119 or 55.1%) had single crises and for most crises ( 338 or 71%), patients attended for only 1 d, when they were given bed rest, assurance, rehydration and analgesia. Patients with complicated painful cr ises were usually referred for admission after initial pain relief and the rest were monitored during the day. In the evening they were given the opti on of hospital admission or allowed home with oral analgesia, Hospital admi ssion for complicated painful crises or inadequate pain relief occurred in 42 (8.8%) crises and home management in 434 (91.2%) crises. Of 186 patients initially selecting home management, 20% returned for further day-care and live (2.7%) died during subsequent admission for that painful crisis, one without other known complications, two with acute chest syndrome (one assoc iated with Salmonella septicaemia), another with Salmonella septicaemia, an d one with dengue haemorrhagic fever. With suitable oral analgesia, adequat e education and support, the majority of severe painful crises in SS diseas e in Jamaica have been managed on an outpatient basis. This model of patien t care may merit assessment in other communities where painful crises are a common clinical problem.