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Three Part Question

In [a patient with a painful sickle cell crisis] how [much time should pass] before [the crisis resolves].

Clinical Scenario

A 39 year old man with sickle cell disease presents to the emergency department with a 24hr history of pain in his arms and legs. His pain is consistent with his usual painful crisis. You wonder to yourself how long on average does a painful crisis last .

Search Strategy

MEDLINE (1966 to present)
EMBASE (1988 to present)
OVID: [sickl$.mp.] AND [exp Anemia/ or anaemia$.mp] OR [exp Anemia, Sickle Cell/ or sickle cell crisis.mp.] AND [painful.mp. and crisis.mp.] AND [exp "Length of Stay"] limited to English language and humans.

Search Outcome

This search yielded 56 articles. Bibliographic references found in these articles were also examined to identify related literature. Only original research articles were included. Three articles directly addressed the question. The Cochrane library was also searched but no relevant results were found. Other mesh terms were also searched such as "time factors" but yielded no more relevant results.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Lennette, J 2000 USA	144 sickle cell anaemia patients who sought treatment for acute painful crisis of varying frequency amounting to 2552 visits to the day hospital over 5years.	Survey	Length of stay in hospital	The average length of stay (LOS) in the day hospital was 4.5hrs (range 2 to 7hrs) while the average LOS in the emergency department was 13hrs (range 11mins to 90hrs)	The aim of the study was not clearly stated. No mention of any ethical approval.
Westerman,M 1997 USA	15 adults, aged 21 years and older, with sickle cell disease.	Survey	Length of stay in hospital	33% (on average) of total episodes were shorter lasting(less than 48hrs). 20% of these total episodes were 24hr episodes and 13% were 48 hr episodes.	Small sample size Selection bias
Ballas, S 2005 USA	182 adult patients with SS were followed from January 1998 through to December 2002	Prospective cohort longitudinal observational study	Length of stay in hospital	The average length of stay was 7.6 days in hospital.	small sample size

Comment(s)

Most painful episodes are managed at home with oral analgesia and fluids by the patient. The evidence suggests that the sickle cell crisis is very variable both in the severity of pain, the location and the time period for which the crisis lasts. It has been shown that the crisis episode may last from a few minutes to weeks. Fortunately crisis which are severe enough to require hospitalisation are few and far between. Data from one study indicated that the average rate was 0.8 episode per patient per patient-year. [2]For most patients the painful crisis that does not require hospitalisation resolves within five to seven days. However in those requiring hospitalisation for severe pain the crisis may persist for weeks to months.[1]

Clinical Bottom Line

The time length of a crisis is very variable, but it usually last between 5 and 7 days.

References

1. Lennette, J Sickle cell anemia day hospital: an approach for the management of uncomplicated painful crises Blood 2000,1130-1137
2. Westerman, M Assessment of painful episode frequency in sickle-cell disease American journal of haematology 1997;183-188
3. Ballas, S et al Hospital readmission for adult acute sickle cell painful episodes: frequency, etiology and prognostic significance American journal of haematology 2005;17-24
4. Platt OS et al Pain in sickle cell disease. Rates and risk factors New England Journal of Medicine 1991;11-16
5. Shapiro BS The management of pain in sickle cell disease. Pediatric Clinical North American journal 1989;1029-1045