Risk factors associated with increased emergency department utilization in patients with sickle cell disease: a systemat
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REVIEW ARTICLE
Risk factors associated with increased emergency department utilization in patients with sickle cell disease: a systematic literature review Samir K. Ballas 1
&
Carlton Dampier 2,3
Received: 15 April 2020 / Accepted: 27 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Sickle cell disease (SCD), a genetic disorder affecting up to 100,000 patients in the USA, impacts multiple organ systems. The emergency department (ED) is frequently utilized by patients with SCD who have severe pain from vaso-occlusive crises. The goal of this systematic literature review is to identify predictors for ED use among patients with SCD in the USA, as high ED reliance is not ideal because of the potential for discontinuity of care as well as higher costs. PubMed and Embase were searched for articles containing the keywords “sickle cell disease” AND (“emergency” OR “acute care”) AND (“utilization” OR “health care”) published between 2000 and 26 September 2019. A total of 26 publications were identified meeting the following inclusion criteria: report of ED or acute care clinic use; report of health care utilization for SCD; and report of ED visits independent of hospital admission, ED revisits, inpatient care visits, and SCD care unit visits. Articles unavailable in English or those focused on populations outside the USA were excluded. Of the 26 articles included, 4 were prospective and the remainder were retrospective. Qualitative analysis of the articles revealed a higher rate of ED utilization among adults than children, patients with public insurance than private insurance, and patients with more comorbidities, complications, or pain. Age and pain levels were both commonly cited as predictors of ED utilization. Additional prospective and interventional studies are needed to further define predictors of ED utilization and to uncover treatments that decrease ED visits. Keywords Emergency medicine . Sickle cell disease . Systemic literature review . Vaso-occlusive crisis
Introduction Sickle cell disease (SCD) is a complex genetic disorder that affects multiple organ systems and is characterized by the presence of abnormal erythrocytes [1]. SCD is caused by a missense
* Samir K. Ballas [email protected] Carlton Dampier [email protected] 1
Cardeza Foundation for Hematologic Research, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1020 Locust Street Suite 394, Philadelphia, PA 19107, USA
2
Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Emory Healthcare, Atlanta, GA, USA
3
AFLAC Cancer and Blood Disorders Center, Atlanta, GA, USA
mutation in the human beta globin gene (HBB) leading to the hemoglobin variant HbS. Patients with SCD can be homozygous (HbSS) or heterozygous for the mutation (HbSC) [1]. HbS–β0thalassemia is a form of SCD that is clinically similar in severity to HbSS [1]. SCD predominantly affects individuals of African descent, and it is ch
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