Management of sickle cell pain crisis in the emergency department at teaching hospitals

The purpose of this study is to determine the frequency and variety of stra tegies being used in the Emergency Department (ED) management of sickle cel l pain crisis (SCPC), One thousand randomly selected academic emergency phy sicians received a multiple choice survey; 549 (55%) completed the survey. Forty-five percent of respondents treat patients with SCPC every week or al most every shift. Twenty percent use protocols for management of SCPC. Resp ondents consider pain refractory to outpatient treatment if it is persisten t after two (23%) or three (53%) doses of parenteral analgesic. Meperidine or morphine is the most common initial analgesic. In the routine management of uncomplicated SCPC, i.v. analgesics, i.v. hydration, oxygen therapy, an d complete blood counts are often or always used by 67, 71, 66, and 82% of respondents, respectively. Same patterns in the diagnostic and therapeutic management of patients with SCPC in the ED are identified, but overall prac tice is highly variable. Some popular elements of care are divergent from t hose suggested by the scientific Literature. (C) 1999 Elsevier Science Inc.