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Assessment and Prediction of Pruritus in Sickle Cell Disease Patients: A Preliminary Study

Hanes, Deborah MSN, RN, CNS, ARNP, OCN; Jefferson-Gordon, Judy MS, MBA, RN-BC; Lindsey, Amy RN, PMHCNS-BC; O’Connor, Stefani MS, CCM; Petty, Lorie MS, RN, CNL; Weiss, Mary BS, RN, CCRC; Nnadi, Massa MSN, RN-BC, CNL; Overcash, Janine PhD

doi: 10.1097/NUR.0b013e3182a0ba46
Feature Article

Purpose/Objectives: The purpose of this study was to better predict and assess pruritus in inpatients and outpatients with sickle cell disease. The aims were to describe the incidence and severity of pruritus using the visual analog scale (VAS) and the National Cancer Institute Common Toxicity Criteria (CTC) scale and to predict pruritus from common complications.

Design: This study was a prospective, cross-sectional design.

Setting: The study was conducted at a Midwestern National Cancer Institute hospital.

Sample: This prospective, cross-sectional design included patients with a diagnosis of sickle cell disease who were older than 18 years.

Methods: A demographic data form was used to collect biographical characteristics, and the CTC scale and VAS were used to evaluate pruritus.

Results: The participants (n = 56) were mostly women (62%) and outpatients (58%) and the mean number of complications was 1.9. The mean VAS score was 3.75, and the CTC score was 1.55. For inpatients, the mean VAS score was 5.17, and the CTC score was 1.65. For outpatients, the mean VAS score was 2.76, and CTC score was 1.56. The sensitivity and specificity for the VAS were 75% and 93%, respectively. The CTC scale was 56.2% and 100%, respectively. The difference in the area under the curve between the VAS and the CTC scale was 11.4% in favor of the VAS. Among complications (pulmonary hypertension, liver insufficiency, acute chest syndrome, renal insufficiency, iron overload, and chronic pain medication), chronic pain medication was the only significant predictor.

Conclusions: Pruritus is common particularly in inpatients as well as outpatients. The VAS is a more sensitive and specific tool to measure pruritus. Chronic pain medication use is a predictor of pruritus.

Implications: Clinicians must make patients aware that pruritus exists especially when pain medication is administered or prescribed.

Author Affiliations: Clinical Nurse Specialist (Ms Hanes), Clinic Nurse Manager (Ms Jefferson-Gordon), Mental Health Clinical Nurse Specialist (Ms Lindsey), Clinical Educator (Ms O’Connor), Staff Nurses (Mss Petty and Weiss), Nurse Educator (Ms Nnadi), and Director of Nursing Research (Dr Overcash), The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, and Richard J. Solove Research Institute, Columbus, Ohio.

There are no funding sources to disclose.

The authors report no conflicts of interest.

Correspondence: Janine Overcash, PhD, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Ho, 1585 Neil Ave, Columbus, OH, 43210 (janine.overcash@osumc.edu).

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins