scholarly journals Air pollution and children's health: sickle cell disease

2015 ◽  
Vol 31 (2) ◽  
pp. 265-275 ◽  
Author(s):  
Silvia Maria de Macedo Barbosa ◽  
Sylvia Costa Lima Farhat ◽  
Lourdes Conceição Martins ◽  
Luiz Alberto Amador Pereira ◽  
Paulo Hilário Nascimento Saldiva ◽  
...  
Keyword(s):  
Air Pollution ◽  
Sickle Cell Disease ◽  
Emergency Room ◽  
Sickle Cell ◽  
Cardiovascular Health ◽  
Pediatric Emergency ◽  
Emergency Room Visits ◽  
Cell Disease ◽  
Day Of The Week ◽  
Pain Symptoms

The hallmarks of sickle cell disease are anemia and vasculopathy. The aim of this study was to assess the association between air pollution and children's emergency room visits of sickle cell patients. We adopted a case-crossover design. Daily counts of children's and adolescents' sickle cell disease emergency room visits from the pediatric emergency unit in São Paulo, Brazil, were evaluated from September 1999 to December 2004, matching by temperature, humidity and controlling for day of the week. Interquartile range increases of the four-day moving averages of PM10, NO2, SO2, CO, and O3 were associated with increases of 18.9% (95%CI: 11.2-26.5), 19% (95%CI: 8.3-29.6), 14.4% (95%CI: 6.5-22.4), 16,5% (95%CI: 8.9-24.0), and 9.8% (95%CI: 1.1-18.6) in total sickle cell emergency room visits, respectively. When the analyses were stratified by pain, PM10 was found to be 40.3% higher than in sickle cell patients without pain symptoms. Exposure to air pollution can affect the cardiovascular health of children and may promote a significant health burden in a sensitive group.

Economic Burden of Sickle Cell Disease among Children and Adults.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 958-958 ◽  
Author(s):  
Abraham G. Hartzema ◽  
Teresa L. Kauf ◽  
Thomas D. Coates ◽  
Liu Huazhi ◽  
Nakita Mody-Patel
Keyword(s):  
Sickle Cell Disease ◽  
Emergency Room ◽  
Medical Care ◽  
Resource Utilization ◽  
Sickle Cell ◽  
Economic Burden ◽  
Medical Costs ◽  
Emergency Room Visits ◽  
Cell Disease ◽  
The Cost

Abstract Background: The economic burden of sickle cell disease (SCD) has not been determined. Cost-of-care estimates improve health care planning, inform research priorities, and contribute to an understanding of the cost-effectiveness of new SCD treatments. The objectives of this study were examine resource utilization in the Florida Medicaid population; to estimate the cost of medical care for SCD patients; and to examine the proportion of medical care costs attributable to SCD versus other morbidities. Methods: Pediatric (0 – 19 years; y) and adult (> 20 y) patients with a diagnosis of SCD between 1/2001–12/2005 were identified from Florida Medicaid claims. Patients with at least 1 inpatient or 2 outpatient SCD claims at least 30 days apart and ≥6 Medicaid-eligible months, not necessarily consecutive, were included in the analysis. Medicaid administrative data consist of medical and pharmacy utilization and reimbursement claims for medically-needy and low-income recipients. Resource utilization and costs were estimated using paid claims for hospitalizations, emergency room visits, outpatient visits, pharmacy claims, and other care (blood transfusions, hydroxyurea, iron chelation, serum ferritin tests). Claims containing a primary or secondary ICD-9 code indicating SCD were considered “SCD-related”; all other claims were classified as “non-SCD-related”. Individuals aged >65 y and/or dually eligible for Medicare or other health insurance were excluded. Annualized costs were estimated by multiplying mean cost per patient-month by 12. All costs were inflated to 2005 US$ using the medical care component of the Consumer Price Index. Results: A total of 4,294 individuals met study inclusion criteria. Mean age at first claim was 14.5 y (range: 0–64 y; SD 13.2); 55.8% were female; 79.1% African-American. Mean SCD-related costs for pediatric (0–9 y) and adolescent (10–19 y) patients were estimated at $5,292 and $11,508 per year, respectively. Overall, 66% of total medical costs were related to SCD. The distribution of SCD-related costs was bimodal, with the youngest (0–9 y) and oldest (50–64 y) having the lowest proportion of SCD-related costs (53.7% and 35.3%, respectively). Non-SCD-related costs increased with age, ranging from $4,548 annually for ages 0–9 to $16,656 for ages 50–64. While SCD accounted for the largest proportion of total medical costs for patients 10–19 y (77.27%; $11,508), absolute SCD costs were highest for patients 30–39 y (67.1%; $21,792). Cost distributions were similar for males and females. Hospitalizations accounted for 80.5% of all SCD-related costs; emergency room visits, 3.2%; office visits, 0.9%; outpatient drugs, 3.6%; other medical care, 11.7%. Total discounted medical costs (3%) for a SCD patient from birth through age 45 were estimated at $448,460, with 67% of costs related to SCD. Conclusion: Our results suggest that the burden of SCD is substantial. Moreover, non-SCD-related medical costs for SCD patients are considerably higher than expenditures reported for the general US population. While our results reflect the payer’s perspective, the clinical, humanistic, and economic burden of care on individual patients also is likely high. Interventions designed to prevent SCD complications and keep patients out of the hospital may reduce the significant economic burden of the disease.

scholarly journals Effects of Environmental Changes on Emergency Rooms Visits for Adult Sickle Cell Disease

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4861-4861
Author(s):  
Samip Master ◽  
Abhishek Patel ◽  
Richard Preston Mansour
Keyword(s):  
Sickle Cell Disease ◽  
Emergency Room ◽  
Adult Patient ◽  
Sickle Cell ◽  
Acute Pain ◽  
Emergency Room Visit ◽  
Environmental Changes ◽  
Emergency Room Visits ◽  
Cell Disease ◽  
Weather Changes

Background: Acute pain crises from vaso occlusive episodes are major cause of morbidity, hospitalization and emergency room visits for patients with sickle cell disease. Major causes of acute painful crises have been attributed to dehydration, infections and fever. Weather change has also been attributed as one of the major cause of acute pain crises by physicians and patients. Data on effects of environmental changes on acute pain crises in patients with sickle cell disease is mixed. Here we report our investigation to see if number of emergency room visits for adult patients with SCD were associated with environmental changes. Method: At our hematology clinic we take care of around 300 adult patients with SCD and we have on average around 11,000 emergency room visit per years from these patients. Electronically from EHR (Electronic health Record), we pulled out data on number of emergency room visit every day for adult patient with SCD in year 2015.We also gathered data on daily environmental changes from a national weather website for the year 2015 and collected data on daily temperature changes, humidity and precipitation/rain in our area. We did analysis to see if there was any correlation between the weather changes and emergency room visit. Results: As shown in graphs below, there was no correlation between the number of ER visits and weather changes in adult patient with SCD. Conclusion: Our analysis showed that there was no correlation between number of ER visit for adult patient with SCD and weather changes like -temperature, humidity and precipitation/rain. ER Visits and Precipitation ER visits, temperature and humidity Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals All-Cause Health Care Resource Utilization in Individuals with Sickle Cell Disease

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5582-5582
Author(s):  
Jigar Rajpura ◽  
Joseph Thomas
Keyword(s):  
Health Care ◽  
Sickle Cell Disease ◽  
Emergency Room ◽  
Sickle Cell ◽  
Health Care Resource ◽  
Emergency Room Visits ◽  
Cell Disease ◽  
Term Care ◽  
Outpatient Visits ◽  
Hospital Days

Abstract Introduction Clinical manifestations of Sickle Cell Disease (SCD) range from frequent fatigue and anemia to severe complications involving multiple organs. We estimated all cause health care resource utilization in individuals with SCD as compared to individuals without SCD. Methods Data from the Truven multi-state Medicaid claims database were used for all analyses. Sample inclusion criteria was being enrolled in covered health plan from January 1, 2012 through December 31, 2012. A cohort of individuals with SCD was identified based on having at least one inpatient or two or more outpatient claims with ICD-9-CM codes for sickle-cell thalassemia without crisis (282.41), sickle-cell thalassemia with crisis (282.42), Sickle-cell disease, unspecified (282.60), Sickle-cell-S disease without crisis (282.61), Sickle-Cell-S disease with crisis (282.62), Sickle-cell-C disease without crisis (282.63), Sickle-cell-C disease with crisis (282.64), other sickle-cell disease without crisis (282.68), or other sickle-cell disease with crisis (282.69). From the continuously enrolled individuals, a cohort of individuals without SCD was identified by matching individuals with SCD one-to-one on age, gender, and ethnicity. Means and 95 percent confidence intervals were calculated for, number of hospitalizations, hospital days, long term care visits, long term care days, emergency room visits, and outpatient visits. Wilcoxon Mann-Whitney test was employed to assess differences in health care resource utilizations in individuals with and without SCD. Results Among 5,136,748 individuals covered in the study period, 8,652 individuals with SCD were identified and matched to 8,652 individuals without SCD. Majorities of the study sample were black (74%), female (54%), and under 24 years old (64%). Mean annual hospitalizations among individuals with SCD were 1.39 (95 percent C.I.: 1.3 to 1.4, <0.001) as compared to 0.10 (95 percent C.I.: 0.09 to 0.1, p<0.001) hospitalizations in persons without SCD. Mean annual outpatient visits in individuals with SCD were 24.7 (95 percent C.I.: 23.9 to 25.5, p<0.001) as compared to 14.18 (95 percent C.I.: 13.4 to 14.9, p<0.001) outpatient visits in persons without SCD, and, mean annual emergency room visits in individuals with SCD were 3.71 (95 percent C.I.: 3.5 to 3.9, p<0.001) as compared to 0.89 (95 percent C.I.: 0.8 to 0.9, p<0.001) emergency room visits in persons without SCD. Conclusions SCD was associated with higher annual hospitalizations, hospital days, outpatient visits and emergency room visits as compared to individuals without SCD. Disclosures Rajpura: Pfizer Inc.: Research Funding. Thomas:Pfizer Inc.: Research Funding.

A Patient Event Diary Improves Self-Management In Pediatric Sickle Cell Disease Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1723-1723
Author(s):  
Jennifer Alison Busse ◽  
Kranthi Nandan Seelaboyina ◽  
Grace Malonga ◽  
Thomas Moulton
Keyword(s):  
Vitamin D ◽  
Chronic Illness ◽  
Sickle Cell Disease ◽  
Emergency Room ◽  
Patient Outcomes ◽  
Sickle Cell ◽  
Self Management ◽  
Emergency Room Visits ◽  
Cell Disease ◽  
One Year

Abstract Introduction Promotion of chronic illness self-management is crucial to improve outcomes of children with sickle cell disease (SCD). Improvements in patient outcomes and quality of life as well as enhancement in health literacy and patient agency are also imperative. Through an event diary developed by the Bronx Lebanon Hospital Sickle Cell Program, our pediatric SCD patients are better able to track significant health events and health care appointments. This study seeks to validate the effectiveness of the patient event diary as a tool for improvement in self management, allowing for improvement in medication and clinic visit compliance, as well as in a reduction in number of emergency room visits. Additionally, the education section at the beginning of the diary has become an integral teaching tool and reference for patients and their families. It is our hypothesis that the event diary as an educational tool, a self management tool, and a tool for providers, will lead to better management of chronic illness and improved patient outcomes. Methods We utilized laboratory and demographic data from the Bronx Lebanon Hospital Center patient electronic medical record between July 2011 and July 2013. Our sample included a population of 50 sickle cell disease patients aged 0 to 21, median age being 7 years. Sickle cell disease types included SS (64%), SC (32%), Sβ+ thalassemia and Sβ0thalassemia (4%). We used a paired, two tailed t-test to assess patients’ medication compliance on vitamin D (22 patients) and hydroxyurea (14 patients) through 25-hydroxyvitamin D (25-OHD) and MCV (mean corpuscular volume) levels, respectively. Increased MCV was used as a proxy to indicate improved medication compliance in patients on hydroxyurea. We compared patients on hydroxyurea and vitamin D six months before receiving the event diary and six months after. Additionally, we compared compliance with hematology clinic visits one year before and one year after receiving the event diary. We also compared the number emergency room visits during the year before and the year after patients received the event diary. Results 25-OHD data from six months after receiving the event diary showed significantly improved compliance with vitamin D treatment (M = 47, SD = 20) as compared to six months before receiving the event diary (M = 26, SD = 15), t(20) = 2.1, p < 0.05. Additionally, there was a statistically significant improvement in MCV levels six months after receiving the event diary (M=101.6, SD=9.6), as opposed to six months before receiving it (M=97.7, SD=5.6), t(12)=2.2, p<0.05. When looking at patient hematology clinic appointment compliance, there was an improvement, however not statistically significant, in compliance with appointments between one year before (M=33.3%, SD=41.7%) and one year after patients received the event diary (M= 27.2%, SD=30.3%), t(17)=2.1, p=0.2. Emergency department visits did decrease, however not significantly, one year before receiving the event diary (M=1.8, SD=2.5) to one year after receiving the event diary (M= 1.3, SD=1.9), t(47)=2.0, p=0.17. Conclusions These data suggest the patient event diary has significantly improved patient self-management. We believe this effect is due to enhanced understanding of disease processes and increased confidence and skills in self-management of the disease. There is improved compliance with hydroxyurea and vitamin D, as well as a trend toward improvement in clinic visit compliance and decreased emergency room visits. The patient event diary is crucial to improved patient outcomes in the pediatric SCD population, and may be useful for other pediatric populations with chronic illness. It is a significant part of our current practice and our ability to teach and empower patients and their families to manage sickle cell disease while at home. Additionally, this tool allows for better management of patients by providers. The event diary helps to elucidate difficulties in patient self-management and gives better insight into complications patients are experiencing at home. In the future, we hope to see that with improved patient knowledge of sickle cell disease and self-management facilitated by use of the event diary, there will be significantly fewer emergency room visits, fewer hospital admissions, and most important, quality of life. Disclosures: Moulton: HRSA: Research Funding; New York State Grant: Research Funding.

scholarly journals Five-Year Outcomes of Chronic Red Blood Cell Exchange Transfusion Program for Patients with Sickle Cell Disease, the Experience of University of Nebraska Medical Center

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4988-4988
Author(s):  
Omar Abughanimeh ◽  
Steven Ebers ◽  
Mahammed Khan Suheb ◽  
Julie Eclov ◽  
Robin High ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Blood Cell ◽  
Emergency Room ◽  
Sickle Cell ◽  
Red Blood Cell ◽  
Research Funding ◽  
Medical Center ◽  
Emergency Room Visits ◽  
Cell Disease ◽  
The Mean

Abstract Background: Red blood cell exchange (RBCX) is an effective therapy in treatment of acute and chronic complications of sickle cell disease (SCD). It involves exchanging patient's red blood cells (RBCs) with donor RBCs to significantly lower hemoglobin S concentration without subjecting the patient to the risk of iron overload. The University of Nebraska Medical Center (UNMC) established a chronic RBCX program in November 2015, which cared for patients with multiple hemoglobinopathies. In this study, we aim to evaluate some of the outcomes of patients with SCD who joined the program. Methods: This is a retrospective study based on review of medical records of patients with sickle cell disease. We reviewed the health records of patients with SCD who were enrolled in the chronic RBCX program between 11/2015-8/2020 at UNMC. We included patients with SCD, regardless of age, who underwent RBCX in the outpatient setting during the study period. Data were collected to assess if RBCX influenced the frequency of SCD crisis, emergency room visits, hospitalizations, and other sickle cell-related complications. Results: A total of 404 sessions of exchange transfusions were performed between November 2015 and August 2020 for 21 patients with SCD. The study included 9 adults (age ≥ 18 years) and 12 children with a median age of 12 years (2-31 years). During the study period, 3 adults left the program due to relocation out of state, patient's preference, or physician's decision. Table 1 summarizes the population demographic. The most common indication for enrollment in the RBCX program was recurrent sickle cell crisis (Figure 1). The mean number of emergency room visits before enrollment in the RBCX program was 22.5 visits (2-62 visits), which reduced after enrollment to 10.4 visits (0-65 visits), with a difference in mean of 12.1 visits (P=0.0021). The mean number of hospital admissions before enrollment in the RBCX program was 13.2 admissions(0-54 admissions), which also reduced to 6.7 admissions (0-50 admissions), with a significant difference in the means equal to 6. 6 admissions (P=0.0013) (Figure 2). Thirteen patients had a baseline ferritin &gt; 500 ng/ml at enrollment; all of them had a decrease in their baseline ferritin during the study, with 4 of them achieving a new baseline &lt; 500 ng/ml. Six patients had pre-existing antibodies at enrollment due to prior alloimmunization; however, no new alloantibodies were noticed after enrollment. The patients without preexisting antibodies were transfused with Rh and Kell matched blood. The patients with pre-existing antibodies were transfused with phenotypically matched blood. Three patients became pregnant during the study period, and their pregnancies were uncomplicated except for one patient with preeclampsia resulting in early delivery. There was no reportable death, acute chest syndrome, or stroke among the patients during the study period. Conclusion Outpatient chronic RBCX demonstrated safety and feasibility in both adults and children. It also showed promising outcomes in terms of reduction of sickle cell complications, number of emergency room visits and hospitalizations. These results can provide the basis for evaluating RBCX in a prospective study to better understand changes in quality of life and clinical outcomes of patients with SCD and limited therapeutic options. Figure 1 Figure 1. Disclosures Gundabolu: Pfizer: Research Funding; Samus Therapeutics: Research Funding; BioMarin Pharmaceuticals: Consultancy; Bristol-Myers Squibb Company: Consultancy; Blueprint Medicines: Consultancy.

Optimizing Pain Management For Children With Sickle Cell Disease Vaso-occlusive Crisis In The Pediatric Emergency Department

2021 ◽  
Author(s):  
Wilson Andres Vasconez ◽  
Claudia Aguilar-Velez ◽  
Cristina Matheus ◽  
Hector Chavez ◽  
Roxana Middleton-Garcia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Cell Disease

Effectiveness Of An Analgesia Protocol For The Treatment Of Painful Vaso-Occlusive Crisis Of Sickle Cell Disease Patients In Emergency Room: A Retrospective Cohort Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2222-2222
Author(s):  
Veronique Naessens ◽  
Richard Ward ◽  
Kevin H.M. Kuo
Keyword(s):  
Sickle Cell Disease ◽  
Emergency Room ◽  
Sickle Cell ◽  
Conflicts Of Interest ◽  
Care Center ◽  
Median Number ◽  
Cell Disease ◽  
Dose Time ◽  
Chi Squared ◽  
Opiate Administration

Background Painful vaso-occlusive crisis (VOC) is the most frequent complication of sickle cell disease (SCD) and the main reason for interacting with the emergency room (ER). Guidelines highlight the need for rapid opiate delivery (< 30 min.) via specific analgesia protocol in order to achieve rapid pain control and reduce length of stay (LOS). Objectives To determine the rate of utilization of an analgesia protocol for SCD patients presenting with painful VOC to ER. Secondary objectives are to examine the relationship between protocol use, LOS, discharge from ER, time to first opiate delivery, total amount of opiates, and time to readmission. Methods An analgesia protocol, developed according to the BCSH guideline, was deployed in the ER of a major SCD comprehensive care center in Canada since 2009. A retrospective observational study was conducted of all SCD patients who presented to the ER with painful VOC between August 2009 and September 2012. Frequent ER visitor was defined as >3 visits/year. Factors influencing protocol use and discharge from ER were examined via Chi-squared test and multivariable logistic regression. Mann-Whitney U test and multiple regression were used to examine factors related to time to first opiate administration, LOS in ER, total quantity of opiates used, and as well as time to readmission. Results 602 ER visits were included in the analysis, comprising of 116 patients (61 males, 55 females) with 82% HbSS or S/β0. The median number of visits in the observation period was 2 (1 to 90), with 12 patients responsible for 57% of visits. The protocol was used in only 51% of visits, frequent ER attenders were less likely to be treated by the protocol (OR 0.989 per additional visit, p=0.007). Higher pain score on presentation was significantly associated with protocol use (OR 1.194 per 1 point increment, p=0.001), which in turn reduced the time to first opiate administration (69 vs. 108 min., p<0.001). Visits treated by protocol were longer (457 min vs. 385 min. in ER, p<0.001), used more opiates (95 vs. 50 mg PO morphine equi-analgesic dose, p<0.001) and patients were less likely to be discharged home (OR 0.78, p=0.003), though it prolonged the time to next ER admission (22 vs. 15 days, p=0.008). The length of inpatient admission was not affected by prior use of the Protocol in ER. Conclusion In this, the largest single-center report of ER sickle cell care, the rate of protocol use was moderate and although it resulted in faster delivery of first opiate dose, time to delivery did not reach the recommended target of 30 minutes. Protocol use did not positively influence any other outcomes. The protocol was preferentially used in patients who attends the ER infrequently. Further refinement of the protocol may lead to improvements in utilization by ER staff, leading to shorter time to first analgesia administration. This in turn may result in the protocol having a greater impact on patient outcomes in ER. Disclosures: No relevant conflicts of interest to declare.

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