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Oral morphine protocol evaluation for the treatment of vaso-occlusive crisis in paediatric sickle cell patients

Hugo Paquin1, Evelyne D Trottier1, Nancy Robitaille2

  • 1Division of Pediatric Emergency Medicine, CHU Ste-Justine, Montréal, Quebec.

Paediatrics & Child Health
|February 23, 2019
PubMed

Insights

Implementing an oral morphine protocol significantly reduced hospitalizations for children with sickle cell disease (SCD) experiencing vaso-occlusive crisis (VOC). This approach also decreased IV use and emergency department length of stay.

Area of Science:

  • Pediatric Hematology
  • Pain Management
  • Emergency Medicine

Background:

  • Vaso-occlusive crisis (VOC) is a frequent cause of emergency visits and hospital admissions in children with sickle cell disease (SCD).
  • Effective management of VOC is crucial to improve patient outcomes and reduce healthcare burden.

Purpose of the Study:

  • To evaluate the impact of a protocol promoting oral morphine for VOC management in pediatric SCD patients.
  • To assess improvements in care, focusing on hospitalization rates and intervention methods.

Main Methods:

  • Retrospective chart review of SCD patients presenting with VOC.
  • Comparison of data from the year before and after protocol implementation.
  • Primary outcome measured: hospitalization rate.

Main Results:

  • A 43% reduction in hospitalization rate was observed post-protocol implementation.
  • Significant increases in oral morphine use (35%), pain scale utilization (28%), and avoidance of IV line placement (30%).
  • A decrease in emergency department length of stay by 55 minutes.

Conclusions:

  • The oral morphine protocol effectively reduces VOC-related hospital admissions in pediatric SCD patients.
  • The protocol leads to decreased need for intravenous interventions and shorter emergency department visits.
  • This strategy represents a validated approach to improving VOC care in children with SCD.
Abstract

Keywords:
Emergency departmentHematologyPainProtocolSickle cell disease

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