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Trends in Sickle Cell Disease-related Priapism in U.S. Children's Hospitals
Hsin-Hsiao Scott Wang1, Katherine W Herbst2, Jennifer A Rothman3
1Department of Surgery, Duke University Medical Center, Durham, NC.
Insights
Hospital admissions for priapism in males with sickle cell disease (SCD) decreased from 2004 to 2012. However, the overall number of patients diagnosed with SCD-related priapism remained stable, with wide variations in admission rates across hospitals.
Area of Science:
- Hematology
- Pediatric Urology
Background:
- Sickle cell disease (SCD) is a genetic blood disorder.
- Priapism, a prolonged erection, is a known complication of SCD.
- Understanding diagnosis and admission patterns is crucial for managing SCD complications.
Purpose of the Study:
- To determine the incidence of priapism diagnosis and inpatient admissions in males with SCD.
- To analyze trends in priapism diagnosis and admissions over time.
- To investigate variations in priapism admission rates among different hospitals.
Main Methods:
- Retrospective review of the Pediatric Health Information System (PHIS) database.
- Inclusion of males under 21 years old treated between 2004 and 2012.
- Identification of SCD and priapism using ICD-9-CM codes; statistical analysis using logistic regression and GEE models.
Main Results:
- 17,186 males with SCD were analyzed, with 748 priapism admissions (2.1%).
- Priapism admissions significantly decreased from 0.81% in 2004 to 0.44% in 2012 (P < .001).
- The number of patients diagnosed with SCD-related priapism showed no significant trend; older age correlated with higher admission likelihood.
Conclusions:
- While priapism admissions for SCD decreased, the number of diagnosed patients did not change significantly.
- Significant variability exists in priapism admission rates among hospitals.
- Further research into hospital-specific management strategies for priapism in SCD patients is warranted.
Objective:
To define rates of priapism diagnosis and inpatient admission among males with sickle cell disease (SCD).
Patients And Methods:
We retrospectively reviewed the Pediatric Health Information System database for males aged <21 years treated 2004-2012. We identified patients with SCD and priapism based on the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Logistic regression and generalized estimating equation models were used to control for confounding and to adjust for within-hospital clustering of similar patients.
Results:
We identified 17,186 males who were admitted 137,710 times during the study period. Of these, 362 (2.1%) were diagnosed with priapism on 748 admissions. There was a significant decrease in the number of priapism admissions among patients with SCD over time (0.81% in 2004 to 0.44% in 2012, P < .001). The number of patients diagnosed with SCD-related priapism varied over time without a statistically significant trend (2.3% in 2004, 2.69% in 2008, 1.01% in 2012, P = .34). Rates of priapism admissions (0-4.4%) varied widely between hospitals. Older patient age was associated with an increased likelihood of a priapism admission in the multivariate logistic regression model after adjusting for treatment year, hospital region, and for hospital-level clustering of similar patients.
Conclusion:
From 2004 to 2012, the number of admissions for SCD-related priapism declined whereas the number of individual patients diagnosed with SCD-related priapism did not. Rates of priapism-related admissions in males with SCD vary widely among PHIS hospitals.
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