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. 2018 Sep 25;2(18):2412-2417.
doi: 10.1182/bloodadvances.2018018382.

Increased acute care utilization in a prospective cohort of adults with sickle cell disease

Sophie Lanzkron  1 , Jane Little  2 , Joshua Field  3 , Joseph Ryan Shows  4 , Hang Wang  1 , Rebecca Seufert  1 , Jasmine Brooks  1 , Ravi Varadhan  5 , Carlton Haywood Jr  1 , Mustapha Saheed  6 , Chiung Yu Huang  7 , Brandi Griffin  2 , Steven Frymark  3 , Allie Piehet  4 , Derek Robertson  1 , Marc Proudford  1 , Adrienne Kincaid  2 , Charles Green  3 , Lorri Burgess  4 , Marcus Wallace  8 , Jodi Segal  1
Affiliations

Increased acute care utilization in a prospective cohort of adults with sickle cell disease

Sophie Lanzkron et al. Blood Adv. .

Abstract

The ESCAPED (Examining Sickle Cell Acute Pain in the Emergency vs Day Hospital) trial is an ongoing prospective study comparing outcomes of people with sickle cell disease (SCD) seeking care for acute pain management in either an emergency department or specialty infusion clinic. The objective of this paper is to describe the baseline characteristics and health care utilization of patients in the trial. This is a multicenter study across 4 US cities that enrolled all adults with SCD living within 60 miles (96.6 km) of a study site who were expected to have acute care utilization over the study period. Twenty-one percent of participants had no acute care visits in the first 12 months of follow-up. Using negative binomial regression, we describe subject characteristics that predict acute care utilization. Three hundred ninety-one subjects have completed 12 months of follow-up with a mean age of 34.5 years (standard deviation, 11.4), 60% are female. Fifty-four percent of subjects with hemoglobin SS disease and 46% with hemoglobin SC disease had 3 or more acute visits over the study period. The prevalence of chronic pain in this cohort was 68%. Predictors of higher rates of acute care utilization included being unemployed, having chronic pain, being on chronic transfusion therapy, having a history of stroke, and being on disability or on Medicaid. This is the first prospective cohort in the modern era, and it demonstrates much higher rates of acute care utilization than reported in the Cooperative Study of Sickle Cell Disease.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Number of acute care visits in the first 12 months of follow-up in the ESCAPED trial by genotype.
See this image and copyright information in PMC

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