Treatment of sickle cell disease in an infusion centre vs ED leads to better outcomes

Adults with sickle cell disease (SCD) having a vaso-occlusive crisis (VOC) gain substantially better outcomes when treated in an infusion centre (IC) than in an emergency department (ED), a recent study has shown.

The investigators performed this prospective cohort study at four US sites to determine whether care in ICs or EDs resulted in better outcomes for the treatment of uncomplicated VOCs. They recruited 483 adults with SCD living within 60 miles of a study site between April 2015 and December 2016.

Participants were followed for 18 months after enrolment. Outcomes measured were time to first dose of parenteral pain medication, whether pain reassessment was completed within 30 minutes after the first dose, and patient disposition on discharge from the acute care visit. A time-varying propensity score adjustment was used to estimate treatment effects for ICs vs EDs.

Of the enrolled participants, 269 who had acute care visits on weekdays were included in this report. The mean time to first dose was 62 min in ICs and 132 min in EDs (difference, 70 min, 95 percent confidence interval [CI], 54–98; E-value, 2.8), with inverse probability of treatment–weighted adjustment.

Treatment in the IC showed 3.8 times (95 percent CI, 2.63–5.64; E-value, 4.7) greater probability of pain reassessment within 30 min of the first dose of parenteral pain medication compared with treatment in the ED. Moreover, the likelihood that a participant’s visit would end in discharge home was fourfold greater (95 percent CI, 3.0–5.42; E-value, 5.4) with treatment in an IC than in an ED.

Of note, the study was restricted to participants with uncomplicated VOCs.