Trends in pain management of sickle cell disease patients presenting with acute vasoocclusive crises: a multi-center retrospective study in Saudi Arabia

BACKGROUND:
Sickle cell disease (SCD) is a chronic condition characterized by acute vaso-occlusive crisis (AVOC), which is the primary cause of emergency department (ED) visits for SCD patients. Despite recommendations for opioid use to manage AVOC pain, regional variations and biases in pain management persist, particularly in Saudi Arabia, where the prevalence of SCD varies by region.


OBJECTIVE:
To identify national trends in pain management for AVOC in EDs across Saudi Arabia and analyze the duration and frequency of ED visits.


DESIGN:
A multicenter retrospective cohort study


SETTINGS:
Multiple acute care centers in Saudi Arabia under the Ministry of National Guard Health Affairs, including EDs and urgent care centers in Riyadh, Jeddah, Al-Ahsa, Dhahran, and Medina.


PATIENTS AND METHODS:
A total of 421 SCD patients presenting with AVOC between 2016 and 2021 were included. Patients with other complications such as infections or acute chest syndrome were excluded. Data on patient demographics, ED visit frequency, length of stay, and medications administered were collected.


MAIN OUTCOME MEASURES:
The primary outcomes were the duration and frequency of ED visits and the types and frequency of analgesics administered.


SAMPLE SIZE:
The study included 421 patients accounting for 20 508 ED visits.


RESULTS:
The average length of stay per ED visit was 4.7 hours. Morphine was the most frequently used opioid, administered to 86% of patients, while paracetamol was the most commonly used analgesic overall (93%). Regional differences were observed, with less opioid use in the Eastern region, where the disease is less severe due to haplotype variations. Ketamine was used in 13% of cases, predominantly in the Western region.


CONCLUSIONS:
The study highlights a diverse approach to AVOC management across Saudi Arabia, with variations influenced by regional differences and physician practices. Paracetamol and morphine were the primary analgesics, though disparities in opioid use suggest the need for standardized pain management protocols.


LIMITATIONS:
This study was limited to centers under one organization and excluded patients with coexisting conditions, which may limit generalizability.