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Development of interactive algorithm for clinical management of acute events related to sickle cell disease in emergency department.

Forni GL, Finco G, Graziadei G, Balocco M, Rigano P, Perrotta S, Olivieri O, Cappellini MD, De Franceschi L - Orphanet J Rare Dis (2014)

Bottom Line: Sickle cell disease (SCD ORPHA232; OMIM 603903) is a rare hereditary red cell disorder, which global distribution is changed in the last decade due to immigration-fluxes from endemic areas to Western-countries.This has generated the requirement of feasible tools for emergency givers.In the context of the scientific-Italian-Society for the study of Thalassemias and Hemoglobinopathies (SITE), we developed an algorithm with interactive windows to guide physicians in managing SCD patients in EDs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Science and Community Health, University of Milan, Milan, Italy. maria.cappellini@unimi.it.

ABSTRACT
Sickle cell disease (SCD ORPHA232; OMIM 603903) is a rare hereditary red cell disorder, which global distribution is changed in the last decade due to immigration-fluxes from endemic areas to Western-countries. One of the main clinical manifestations of SCD are the acute painful vaso-occlusive crisis, which cause frequent accesses of SCD patients to the emergency departments (EDs). This has generated the requirement of feasible tools for emergency givers. In the context of the scientific-Italian-Society for the study of Thalassemias and Hemoglobinopathies (SITE), we developed an algorithm with interactive windows to guide physicians in managing SCD patients in EDs.

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Related in: MedlinePlus

The developed algorithm shows a series of windows on different clinical presentation of SCD patients at the EDs. In the two blocked windows, we stressed the need to assign at least a triage code yellow to SCD patients in order to give an appropriate therapy for pain control within 30 minutes from patients arrival to the EDs. The boxes for triage each code link to pages, describing the details of the related therapy as shown in Figure 2 or the info about the differential diagnosis or the literature.
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Figure 1: The developed algorithm shows a series of windows on different clinical presentation of SCD patients at the EDs. In the two blocked windows, we stressed the need to assign at least a triage code yellow to SCD patients in order to give an appropriate therapy for pain control within 30 minutes from patients arrival to the EDs. The boxes for triage each code link to pages, describing the details of the related therapy as shown in Figure 2 or the info about the differential diagnosis or the literature.

Mentions: Sickle cell disease (SCD ORPHA232; OMIM 603903) is a rare hereditary red cell disorder characterized by the presence of a point mutation on the β-globin chain, resulting in the synthesis of the pathological hemoglobin S (HbS) [1,2]. The two main clinical manifestations of SCD are chronic hemolytic anemia and acute painful vaso-occlusive crisis (VOCs), related to the entrapment of dense, dehydrated sickle red cells in the microcirculation [1,2]. Since in last two decades, the global distribution of SCD is largely changed due to immigration movements from endemic areas such as Africa to Western countries [3], the development of protocols for the management of acute events is crucially required by emergency givers [4,5]. In fact, SCD patients are the major users of emergency departments (EDs) compared to subjects with other severe hemoglobinopathies, generally feeling to be undertreated during VOCs [6,7]. Pain is the main symptom of VOCs and requires an intensive analgesic treatment. Previous studies have shown longer delay time to the initial analgesic treatment for SCD patients compared to subjects with other acute severe pain syndromes, despite the higher pain score at the admission to the EDs [8,9]. Ballas et al. have recently recommended an early and aggressive treatment of VOCs related to SCD similarly to the strategy developed for the management of acute ischemic stroke [5]. In addition, Glassberg et al. have pointed out that the management of acute VOCs related to SCD by emergency providers is more effective in presence of guidelines [9]. In this context, the scientific Italian Society for the study of Thalassemias and Hemoglobinopathies (SITE) has coordinated a national multidisciplinary working group that developed an algorithm to let the triage operators a fast and appropriate approach to the pediatrics and adult patients with SCD in EDs (Figure 1). The flow-chart of the algorithm has been designed to access, clicking on different buttons, to the detailed description of the diagnostic and therapeutic steps. Each one of the boxes of the algorithm from the green to the red code are interactive and linked to a detailed flow-charts similar to that shown in Figure 2. These flow-charts are evidences based designed and help in decision making processes and therapeutic management of acute VOCs related to SCD. The algorithm has also an introductive section on pathophysiology of SCD and extensive reference section, linked to PubMed in order to allow the physician to rapidly refer to the selected paper. The algorithm can be downloaded from the webpage of the SITE (http://www.site-italia.org) and can interface with the more diffuse hardwares.


Development of interactive algorithm for clinical management of acute events related to sickle cell disease in emergency department.

Forni GL, Finco G, Graziadei G, Balocco M, Rigano P, Perrotta S, Olivieri O, Cappellini MD, De Franceschi L - Orphanet J Rare Dis (2014)

The developed algorithm shows a series of windows on different clinical presentation of SCD patients at the EDs. In the two blocked windows, we stressed the need to assign at least a triage code yellow to SCD patients in order to give an appropriate therapy for pain control within 30 minutes from patients arrival to the EDs. The boxes for triage each code link to pages, describing the details of the related therapy as shown in Figure 2 or the info about the differential diagnosis or the literature.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230640&req=5

Figure 1: The developed algorithm shows a series of windows on different clinical presentation of SCD patients at the EDs. In the two blocked windows, we stressed the need to assign at least a triage code yellow to SCD patients in order to give an appropriate therapy for pain control within 30 minutes from patients arrival to the EDs. The boxes for triage each code link to pages, describing the details of the related therapy as shown in Figure 2 or the info about the differential diagnosis or the literature.
Mentions: Sickle cell disease (SCD ORPHA232; OMIM 603903) is a rare hereditary red cell disorder characterized by the presence of a point mutation on the β-globin chain, resulting in the synthesis of the pathological hemoglobin S (HbS) [1,2]. The two main clinical manifestations of SCD are chronic hemolytic anemia and acute painful vaso-occlusive crisis (VOCs), related to the entrapment of dense, dehydrated sickle red cells in the microcirculation [1,2]. Since in last two decades, the global distribution of SCD is largely changed due to immigration movements from endemic areas such as Africa to Western countries [3], the development of protocols for the management of acute events is crucially required by emergency givers [4,5]. In fact, SCD patients are the major users of emergency departments (EDs) compared to subjects with other severe hemoglobinopathies, generally feeling to be undertreated during VOCs [6,7]. Pain is the main symptom of VOCs and requires an intensive analgesic treatment. Previous studies have shown longer delay time to the initial analgesic treatment for SCD patients compared to subjects with other acute severe pain syndromes, despite the higher pain score at the admission to the EDs [8,9]. Ballas et al. have recently recommended an early and aggressive treatment of VOCs related to SCD similarly to the strategy developed for the management of acute ischemic stroke [5]. In addition, Glassberg et al. have pointed out that the management of acute VOCs related to SCD by emergency providers is more effective in presence of guidelines [9]. In this context, the scientific Italian Society for the study of Thalassemias and Hemoglobinopathies (SITE) has coordinated a national multidisciplinary working group that developed an algorithm to let the triage operators a fast and appropriate approach to the pediatrics and adult patients with SCD in EDs (Figure 1). The flow-chart of the algorithm has been designed to access, clicking on different buttons, to the detailed description of the diagnostic and therapeutic steps. Each one of the boxes of the algorithm from the green to the red code are interactive and linked to a detailed flow-charts similar to that shown in Figure 2. These flow-charts are evidences based designed and help in decision making processes and therapeutic management of acute VOCs related to SCD. The algorithm has also an introductive section on pathophysiology of SCD and extensive reference section, linked to PubMed in order to allow the physician to rapidly refer to the selected paper. The algorithm can be downloaded from the webpage of the SITE (http://www.site-italia.org) and can interface with the more diffuse hardwares.

Bottom Line: Sickle cell disease (SCD ORPHA232; OMIM 603903) is a rare hereditary red cell disorder, which global distribution is changed in the last decade due to immigration-fluxes from endemic areas to Western-countries.This has generated the requirement of feasible tools for emergency givers.In the context of the scientific-Italian-Society for the study of Thalassemias and Hemoglobinopathies (SITE), we developed an algorithm with interactive windows to guide physicians in managing SCD patients in EDs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Science and Community Health, University of Milan, Milan, Italy. maria.cappellini@unimi.it.

ABSTRACT
Sickle cell disease (SCD ORPHA232; OMIM 603903) is a rare hereditary red cell disorder, which global distribution is changed in the last decade due to immigration-fluxes from endemic areas to Western-countries. One of the main clinical manifestations of SCD are the acute painful vaso-occlusive crisis, which cause frequent accesses of SCD patients to the emergency departments (EDs). This has generated the requirement of feasible tools for emergency givers. In the context of the scientific-Italian-Society for the study of Thalassemias and Hemoglobinopathies (SITE), we developed an algorithm with interactive windows to guide physicians in managing SCD patients in EDs.

Show MeSH
Related in: MedlinePlus