Day Hospital Approach to Uncomplicated Vaso-Occlusive Crises in Children with Sickle Cell Disease.

Day hospital management for patients with sickle cell disease experiencing uncomplicated vaso-occlusive pain crises has been described in adult populations as an alternative care delivery system. To date, there are no published studies addressing the utility of this model in pediatric populations. We retrospectively studied all admissions to the Day Hospital at the Texas Children’s Sickle Cell Center since its inception in 2000. A Day Hospital admission was defined as a minimum of two consecutive days of aggressive pain management as an outpatient, including intravenous hydration and analgesics, supported by home treatment over night with oral analgesic and anti-inflammatory agents. We gathered data on demographics, sickle cell genotype, incoming pain scale, provider type (physician versus nurse practitioner), home treatment with narcotics prior to presentation, average daily dose of narcotics administered during admission, length of stay, admission charges, return rate to the emergency department within 48 hrs, and transfer rate from Day Hospital to inpatient care. A total of 35 patients accounted for 80 visits during the study period (2000–2006). Approximately 83% of patients had sickle cell anemia (HbSS). The mean baseline hemoglobin for patients was 9.1 g/dl. Patients were seen equally by physicians and nurse practitioners. Approximately 93% of visits were preceded by home narcotic use within 24hrs of presentation. The mean incoming pain score was 7.9 on a scale from 1 to 10. The mean length of stay was 2.4 days. The return rate for emergency care within 48 hours was 6%. Approximately 40% of patients admitted to the Day Hospital were transferred to inpatient care for unresolved pain or increasing medical needs. We conclude that a dedicated Day Hospital facility has the potential to provide patient-centered, effective, and timely management of vaso-occlusive crises in children as well as adults. It may serve as an alternative to emergency and inpatient care for children with mild to moderate pain. Future studies should compare day hospital care to inpatient hospitalization for differences in length of stay, cost, patient satisfaction, and quality of life.