Pain is the main source of distress in patients with sickle cell disease (SCD), which affects up to 2.6% of the population in Saudi Arabia. Unmanageable pain often termed “crises” may prompt unexpected visits to the emergency department (ED) or other acute healthcare facilities. One study from the Eastern province in Saudi Arabia reported that 64% of SCD patients present to the ED more than three times over a 6-month period. Outpatient follow-up may have a role in preventing ED visits, but this has not been fully explored in Saudi Arabia.
The study aimed to assess the relation between outpatient follow-up and future ED visits due to painful crises in SCD patients.
This is a retrospective, observational study that utilized data from the electronic medical record system at King Abdulaziz Medical City, National Guard Health Affairs in Riyadh. Medical records were searched to identify patients with a labeled diagnosis of sickle cell disease or vaso-occlusive crisis. The study included adult SCD patients who presented at least once to the ED due to a painful crisis between January 2016 and December 2017. Patients’ characteristics and data on each visit were obtained from physicians’ documentation and test results. The time between ED visits due to painful crises was set as the outcome variable. Cox regression analysis with random effects model (frailty model) was used to determine the effect of outpatient follow-up at 15 days, 30 days, and 90 days on the time to next ED visit. Baseline characteristics and previous history of sickle cell complication (acute chest syndrome, avascular necrosis, osteomyelitis, and priapism) were included in the model.
Eighty SCD patients (56% male gender, mean age 25.8 ± 10.4 years, 13% sickle-thalassemia trait, 36% previous history of complication) presented a total of 463 times to the ED due to painful crises. Fifty-four percent of these visits required admission and resulted in a total length of stay of 1,474 hospital days and 49 ICU days. Fifteen percent of visits were associated with a documented infection and 8% of visits were associated with a complication – acute chest syndrome, avascular necrosis, osteomyelitis, or priapism. Attendance to a hematology outpatient clinic within 30 days from discharge significantly reduced the hazard of an ED visit due to painful crisis compared to no follow-up (HR = 0.70, CI95% 0.52–0.94, p = 0.02).
Appropriate outpatient referral at discharge may be associated with decreased ED visits. These benchmark results invite further investigation into the effects of outpatient management on preventing painful crises in SCD patients.