Treatment of uncomplicated vaso-occlusive crises in children with sickle cell disease in a day hospital

Pediatr Blood Cancer. 2008 Jul;51(1):82-5. doi: 10.1002/pbc.21483.


Background: 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. The objective of this study was to characterize and descriptively assess the benefits of a day hospital exclusively designed for children.

Procedure: 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, incoming pain score, provider type, opioid administration, length of stay, and needs for higher level care.

Results: A total of 35 patients, ages 2-19, accounted for 80 episodes during the study period. The median incoming pain score was 8 on a scale from 1 to 10. The median length of stay was 2 days. The return rate for acute care within 48 hr for persistent symptoms was 7%. Seventy-one percent of patients admitted to the Day Hospital were treated without requiring transfer to inpatient care for escalating pain or medical needs.

Conclusions: 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.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Sickle Cell / complications*
  • Anemia, Sickle Cell / drug therapy
  • Child
  • Child, Preschool
  • Day Care, Medical*
  • Hospitalization
  • Humans
  • Outpatients
  • Pain / drug therapy
  • Pain Measurement
  • Quality of Health Care*
  • Retrospective Studies
  • Vascular Diseases / drug therapy*
  • Vascular Diseases / etiology