Table 25Summary of included studies for clinical signs and symptoms of acute complications

Author (year)Patient detailsStudy designAcute complicationPrognostic factors investigatedLocation
Kopecky et al. (2004)50 paediatric patients (age range 5–17 years) who took part in an RCT comparing continuous intravenous infusion of morphine with an oral sustained release formulation of the drug; all patients presented with VOCPost-hoc analysis of RCTAcute chest syndromeExposure to morphine (all patients received intravenous loading dose of 0.15 mg/kg then infusion of at least 0.04 mg/kg/hour)
Oral: sustained-release tablets giving a dose of at least 1.9 mg/kg/hour and placebo infusion
Continuous intravenous infusion: at least 0.04 mg/kg/hour and oral placebo
Canada
Finkelstein et al. (2007)17 paediatric patients (mean age 8.9 years, inclusion <18 years) who presented to the emergency department for painful VOC and developed acute chest syndromeRetrospective, self-matched, case crossover designAcute chest syndromeExposure to morphineCanada
Buchanan et al. (2005)175 paediatric patients (mean age 11 years, inclusion 5–19 years) with VOCRetrospective chart reviewAcute chest syndromeOpioid selection (morphine compared with nalbuphine by intermittent injection or continuous infusion accompanied by patient-controlled analgesia)USA
Lewing et al. (2011)796 paediatric admissions (age range 3–17 years) for acute painful episodes in two institutionsRetrospective chart reviewAcute chest syndromeParenteral narcotic choice (nalbuphine compared with morphine and other opioids)USA
Styles et al. (2000)14 paediatric patients (mean age 12.6 years, range 1.5–20 years) during 21 admissions for VOCProspective cohortAcute chest syndromeSecretory phospholipase A2 (inflammatory mediator)USA
Audard et al. (2010)254 episodes of VOC complications in 161 adult patients (age range 22–34 years)Retrospective cohort studyAcute kidney InjuryLaboratory values (for example WBC, haemoglobin, platelets), echocardiography data (for example left ventricular ejection fraction, cardiac index, stroke index) and pulmonary hypertensionFrance
Baumgartner et al. (1989)53 adult patients (mean age 24.4 years in VOC group and 23.2 years in acute surgical group) with abdominal painRetrospective chart reviewAcute abdomenPain distribution, historical factors (including emesis, similarity to previous cases, precipitating event), physical findings (temperature, peritoneal signs) and laboratory evaluation (WBC, haematocrit, bilirubin)USA
Berger et al. (2009)124 paediatric patients (mean age 8.5 years, inclusion ≤ 18 years) with sickle cell disease and VOCCase-control designOsteomyelitis (acute presentation)Clinical features (pain, fever, swelling and number of affected sites) and WBCCanada
Buchanan and Glader (1978)51 episodes of VOC in 40 paediatric patients (age range 5 months to 21 years)Retrospective design (unclear)Bacterial infection (14 episodes of bacteraemia, five of which were associated with localised focus of infection, including pneumonia, gastroenteritis and pyelonephritis)Total WBC, segmented polymorphonuclear leukocytes (PMN), non-segmented PMNUSA
Ander et al. (1997)94 visits by 38 adult patients (mean age 30 and 33 years for males and females respectively) who presented to the ED with pain typical of a VOCRetrospective cohortPneumonia and UTISigns and symptoms including fever, chills, cough, shortness of breath, sputum production, chest pain, haemoptysis, abnormal pulmonary examination and temperature above 37.8°CUSA
Pollack et al. (1991)71 patients (>14 years of age) with 134 separate ED visits for acute painful episodesProspective clinical study (some retrospective data collection)Pneumonia and UTIPulmonary symptoms (temperature, chest pain, cough, haemoptysis and shortness of breath), systemic symptoms (fever, chills, nausea, vomiting, diarrhoea, upper respiratory infection) and laboratory data (WBC, haematocrit, peripheral reticulocyte count, peripheral absolute neutrophil count, urine pH and urine specific gravity)USA
Bernard et al. (2008)884 ED visits by 125 adult patients (mean age 36.3 years, age range 19–66 years); 199 of 284 patients admitted were found to have one or more of the outcomes; majority of ED visits were for acute painful episodesOutcome prediction study using a retrospective cohortNo specific complication; outcomes included acute chest syndrome, aplastic crisis, splenic sequestration and blood transfusion or antibiotic administrationThese included type of sickle cell disease, clinical symptoms (for example, pain similar to previous, chills, abnormal temperature) and laboratory values (haemoglobin)USA
Chapman et al. (2004)86 visits by 30 paediatric patients (age range 11 months to 18 years old, median age 9.5 years)Retrospective chart reviewNo specific complication; complicated visits defined as admission to hospital, need for antibiotics or blood products within 48 hours, or development of acute chest syndrome or aplasia within 48 hoursHaemoglobin value, WBC and differential reticulocyte countUSA

Abbreviations: ED, emergency department; UTI, urinary tract infection; VOC, vaso-occlusive crisis; WBC, white blood cell count.

From: 2, Evidence review and recommendations

Cover of Sickle Cell Acute Painful Episode
Sickle Cell Acute Painful Episode: Management of an Acute Painful Sickle Cell Episode in Hospital.
NICE Clinical Guidelines, No. 143.
Centre for Clinical Practice at NICE (UK).
Copyright © 2012, National Institute for Health and Clinical Excellence.

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