Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2012 Jun;19(6):664-72.
doi: 10.1111/j.1553-2712.2012.01364.x.

Risk factors for increased ED utilization in a multinational cohort of children with sickle cell disease

Jeffrey A Glassberg  1 , Jason Wang, Robyn Cohen, Lynne D Richardson, Michael R DeBaun
Affiliations
Multicenter Study

Risk factors for increased ED utilization in a multinational cohort of children with sickle cell disease

Jeffrey A Glassberg et al. Acad Emerg Med. 2012 Jun.

Abstract

Objectives: The objective was to identify clinical, social, and environmental risk factors for increased emergency department (ED) use in children with sickle cell disease (SCD).

Methods: This study was a secondary analysis of ED utilization data from the international multicenter Silent Cerebral Infarct Transfusion (SIT) trial. Between December 2004 and June 2010, baseline demographic, clinical, and laboratory data were collected from children with SCD participating in the trial. The primary outcome was the frequency of ED visits for pain. A secondary outcome was the frequency of ED visits for acute chest syndrome.

Results: The sample included 985 children from the United States, Canada, England, and France, for a total of 2,955 patient-years of data. There were 0.74 ED visits for pain per patient-year. A past medical history of asthma was associated with an increased risk of ED utilization for both pain (rate ratio [RR] = 1.28, 95% confidence interval [CI] = 1.04 to 1.58) and acute chest syndrome (RR = 1.60, 95% CI = 1.03 to 2.49). Exposure to environmental tobacco smoke in the home was associated with 73% more ED visits for acute chest syndrome (RR = 1.73, 95% CI = 1.09 to 2.74). Each $10,000 increase in household income was associated with 5% fewer ED visits for pain (RR = 0.95, 95% CI = 0.91 to 1.00, p = 0.05). The association between low income and ED utilization was not significantly different in the United States versus countries with universal health care (p = 0.51).

Conclusions: Asthma and exposure to environmental tobacco smoke are potentially modifiable risk factors for greater ED use in children with SCD. Low income is associated with greater ED use for SCD pain in countries with and without universal health care.

PubMed Disclaimer

Conflict of interest statement

Disclosures: The authors have no potential conflicts of interest or other financial disclosures to report.

Figures

Figure 1
Figure 1
Patient Selection
Figure 2
Figure 2
Association between Categories of Household Income and ED Use for Pain
See this image and copyright information in PMC

References

    1. Hassell KL. Population estimates of sickle cell disease in the U.S. Am J Prev Med. 2010;38:S512–S521. - PubMed
    1. Hebbel RP, Boogaerts MA, Koresawa S, Jacob HS, Eaton JW, Steinberg MH. Erythrocyte adherence to endothelium as a determinant of vasocclusive severity in sickle cell disease. Trans Assoc Am Physicians. 1980;93:94–99. - PubMed
    1. Frenette PS. Sickle cell vasoocclusion: heterotypic, multicellular aggregations driven by leukocyte adhesion. Microcirculation. 2004;11:167–177. - PubMed
    1. Belcher JD, Marker PH, Weber JP, Hebbel RP, Vercellotti GM. Activated monocytes in sickle cell disease: potential role in the activation of vascular endothelium and vaso-occlusion. Blood. 2000;96:2451–2459. - PubMed
    1. Antonucci R, Walker R, Herion J, Orringer E. Enhancement of sickle erythrocyte adherence to endothelium by autologous platelets. Am J Hematol. 1990;34:44–48. - PubMed

Publication types

Substances