The associations between air quality and the number of hospital admissions for acute pain and sickle-cell disease in an urban environment

Abstract The clinical severity of sickle cell disease (SCD) is dependent on genetic and environmental variables. The impact of environmental factors on disease is a major public health issue and air pollution has been consistently correlated with poor health outcomes. Environmental factors in SCD have been poorly studied. We have retrospectively studied the numbers of daily admissions with vaso-occlusive sickle cell pain to King’s College Hospital, London, in relation to local daily air quality measurements. We analysed 1047 patient episodes over 1400 days (1st January 1998 to 31st October 2001). Statistical time series analysis was performed using cross-correlation function (CCF), where the observations of one series are correlated with the observations of another series at various lags and leads, values >0.05 being significant. This showed a significant association between increased numbers of admissions and low levels of nitric oxide (NO) (CCF=0.063), low levels of carbon monoxide (CO) (CCF=0.064) and high levels of ozone (O3) (CCF=0.067). There was no association with sulphur dioxide (SO2), nitric dioxide (NO2) or dust. The significant results were further examined using quartile analysis. This confirmed that increased numbers of hospital admissions were associated with high levels of O3 (oneway ANOVA p=0.039) and low levels of CO (oneway ANOVA p=0.042). Low NO levels were also associated with increased admissions, not however reaching statistical significance on quartile analysis (oneway ANOVA p=0.158). O3 levels show marked seasonal variation, with high levels occurring in summer months in the UK. We have previously shown a trend towards increased admissions in the summer months with acute sickle related pain, whereas other groups, which are primarily based in rural tropical climates, found increased admissions in cold, rainy months. The adverse effect of high O3 levels may explain this difference. There is no direct evidence to explain the mechanism by which high O3 levels leads to vaso-occlusion in SCD but high levels of O3 have been linked to reduced respiratory function, which may in turn precipitate vaso-occlusion. Independent studies have shown high CO levels are linked to increased respiratory and cardiovascular admissions. Paradoxically we found that high CO levels were linked to decreased admission numbers and may be protective against acute pain in SCD. CO may confer benefit by forming carboxyhaemoglobin that cannot polymerise resulting in decreased sickling. Previous studies have shown prolonged red cell survival in vivo following administration of CO to patients with SCD. Our study also suggests higher levels of atmospheric NO are linked to fewer admissions. NO is known to be central in the pathophysiology of vaso-occlusion and sickle cell patients are thought to have functional deficiency of NO. Many groups have reported inhaled NO as beneficial in the treatment of sickle pain. Our study suggests air quality has a significant effect on acute pain in SCD and that patients should be counselled accordingly. Based on these findings it would be appropriate to warn patients that high O3 levels might precipitate complications of SCD. The potential beneficial effect of CO and NO is intriguing and requires further investigation.

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Windy weather and low humidity are associated with an increased number of hospital admissions for acute pain and sickle cell disease in an urban environment with a maritime temperate climate

British Journal of Haematology ◽

10.1111/j.1365-2141.2005.05799.x ◽

2005 ◽

Vol 131 (4) ◽

pp. 530-533 ◽

Cited By ~ 38

Author(s):

Simon Jones ◽

Edward R. Duncan ◽

Nikki Thomas ◽

Joan Walters ◽

Moira C. Dick ◽

...

Keyword(s):

Sickle Cell Disease ◽

Urban Environment ◽

Sickle Cell ◽

Acute Pain ◽

Hospital Admissions ◽

Temperate Climate ◽

Cell Disease ◽

Windy Weather ◽

Low Humidity

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Inpatient pain management in sickle cell disease

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz228 ◽

2019 ◽

Vol 76 (23) ◽

pp. 1965-1971 ◽

Cited By ~ 2

Author(s):

Stefanie M Zassman ◽

Francis J Zamora ◽

John D Roberts

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Acute Pain ◽

Pain Control ◽

Hospital Admissions ◽

Healthcare Providers ◽

Emergency Department Visits ◽

Cell Disease ◽

Usual Practice ◽

Blood Disorder

Abstract Purpose A novel strategy for management of acute pain associated with sickle cell disease (SCD), referred to as the oral tier approach, is described. Summary SCD is an inherited blood disorder characterized by episodic acute pain known as vaso-occlusive crisis (VOC), which is the most common reason for emergency department visits and hospital admissions in patients with SCD; these patients are often treated with parenteral opioids on admission and then transitioned to oral opioids prior to discharge. In this report, experience with use of the oral tier approach in 3 patients with SCD hospitalized for management of VOC is reported. As per usual practice, acute pain was initially managed with parenteral opioids via patient-controlled analgesia (PCA). Once pain control was established, an oral tier was added. The oral tier consisted of 3 orders. The first order was for an oral opioid, to be administered every 3 hours on a scheduled basis; however, the patient could refuse 1 or more of these scheduled doses. Two additional orders specified that the patients could receive additional oral opioids in incremental doses for moderate (grade 4–7) or severe (grade 8–10) pain if appropriate. To facilitate transition to an oral regimen with which the patients might be discharged, they were encouraged to use oral opioids in preference to parenteral opioids. Opioid usage and average daily pain scores for the 3 patients are reported. Conclusion Healthcare providers can use the oral tier approach to facilitate rapid inpatient conversion from i.v. PCA to oral opioids while providing adequate pain control in patients with SCD who develop VOC.

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Procedures, Pain, and Parents

PEDIATRICS ◽

10.1542/peds.87.4.563 ◽

1991 ◽

Vol 87 (4) ◽

pp. 563-565

Author(s):

HOWARD BAUCHNER

Keyword(s):

Sickle Cell Disease ◽

Lumbar Puncture ◽

Sickle Cell ◽

Acute Pain ◽

Cell Disease ◽

Emergency Rooms ◽

Pharmacological Agents ◽

The Past ◽

The Subject

During the past decade certain types of pain in children have been the subject of much research and discussion. The pain associated with cancer, sickle cell disease, and the preoperative and post-operative periods have all been extensively studied and reviewed.1-4 Less information is available about acute pain inflicted in emergency rooms. Children commonly undergo procedures such as venipuncture, intravenous cannulation, lumbar puncture, and manipulation of fractures in emergency rooms without the benefit of any analgesia. What techniques are available to reduce the pain and anxiety that children feel when they undergo procedures? Traditionally, physicians have tried to reduce pain by using pharmacological agents.

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Sickle Cell Disease: Considerations for Acute Pain Management in the Hematology-Oncology Ambulatory Setting

Clinical Journal of Oncology Nursing ◽

10.1188/21.cjon.605-607 ◽

2021 ◽

Vol 25 (5) ◽

pp. 605-607

Author(s):

Elizabeth Pohl

Keyword(s):

Pain Management ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Acute Pain ◽

Ambulatory Setting ◽

Cell Disease ◽

Acute Pain Management

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The Use of a Low-Dose Ketamine Infusion in the Management of an Acute Pain Crisis in a Patient with Sickle Cell Disease

Anesthesia & Clinical care ◽

10.24966/acc-8879/100008 ◽

2015 ◽

Vol 2 (1) ◽

pp. 1-4

Author(s):

Jingping Wang ◽

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Acute Pain ◽

Low Dose ◽

Cell Disease ◽

Ketamine Infusion ◽

Pain Crisis

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Risk-Score Based Strategy to Minimize Antibiotic Exposure in Children With Sickle Cell Disease and Fever

10.21203/rs.3.rs-756018/v1 ◽

2021 ◽

Author(s):

Elena Maria Rincón-López ◽

María Luisa Navarro Gómez ◽

Teresa Hernández-Sampelayo Matos ◽

David Aguilera-Alonso ◽

Eva Dueñas Moreno ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Risk Score ◽

Bacterial Infections ◽

Hospital Admissions ◽

Empirical Therapy ◽

Antibiotic Exposure ◽

Cell Disease ◽

Optimal Score ◽

A Prospective Study

Abstract Severe bacterial infections (SBI) have become less frequent in children with sickle cell disease (SCD) in the last decades. However, because of their potential risk of SBI, they usually receive empirical therapy with broad-spectrum antibiotics when they develop fever and are hospitalized in many cases. We performed a prospective study including 79 SCD patients with fever [median age 4.1 (1.7–7.5) years, 78.5% males; 17 of the episodes were diagnosed with SBI and 4 of them were confirmed] and developed a risk score for the prediction of SBI. The optimal score included CRP > 3 mg/dl, IL-6 > 125 pg/ml and hypoxemia, with an AUC of 0.91 (0.83–0.96) for the prediction of confirmed SBI and 0.86 (0.77–0.93) for possible SBI. We classified the patients in 3 groups: low, intermediate and high risk of SBI. Our risk-score based management proposal could help to safely minimize antibiotic treatments and hospital admissions in children with SCD at low risk of SBI.

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Air Drep—A Retrospective Study Evaluating the Influence of Weather Conditions and Viral Epidemics on Vaso-Occlusive Crises in Patients with Sickle Cell Disease Living in French Guiana

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16152724 ◽

2019 ◽

Vol 16 (15) ◽

pp. 2724

Author(s):

Marie-Claire Parriault ◽

Claire Cropet ◽

Aniza Fahrasmane ◽

Stéphanie Rogier ◽

Michaël Parisot ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

French Guiana ◽

Hospital Admissions ◽

Weather Conditions ◽

Therapeutic Education ◽

Targeted Prevention ◽

Prevention Measures ◽

Cell Disease ◽

Emergency Visits

(1) Objectives: French Guiana is the French territory most affected by sickle cell disease (SCD). This study investigates the associations between different environmental factors relative to climate, infectious outbreaks, and emergency visits or weekly hospital admissions for vaso-occlusive crisis (VOC). The identification of risk factors would lead to better patient care and patient management, and more targeted prevention and therapeutic education for patients with SCD in French Guiana. (2) Methods: This study was performed using data collected from the medicalized information system and emergency medical records of Cayenne General Hospital, between 1 January 2010 and 31 December 2016. ARIMA models were used to investigate the potential impact of weather conditions and flu epidemics on VOC occurrence. (3) Results: During the study period, 1739 emergency visits were recorded among 384 patients, of which 856 (49.2%) resulted in hospitalization, 811 (46.6%) resulted in hospital discharge, and 72 (4.2%) in another orientation. Decreased temperature and decreased humidity were both independent factors associated with an increase of VOC cases (p = 0.0128 and p = 0.0004, respectively). When studying severe VOC (leading to hospitalization, with or without prior emergency visit), 2104 hospital admissions were recorded for 326 patients. The only factor associated with severe VOC, in the multivariate analysis, was flu epidemics (p = 0.0148). (4) Conclusions: This study shows a link between climate, flu epidemics, and VOC in French Guiana. Patient’s awareness of risks related to climate and flu epidemics should be encouraged, as home prevention measures can help avoid painful crises. Moreover, physicians should encourage patients to get immunized for influenza every year.

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