Background: Sickle cell disease (SCD), an autosomal recessive disorder resulting in abnormal hemoglobin S production is one of the commonest genetic disorders in Saudi Arabia and the worldwide. The clinical implications of SCD are diverse and any organ system may be affected which results in high morbidity and mortality. The acute clinical manifestations of SCD can occur in vaso occlusive, hematologic and infectious crises. Patients with sickle cell disease are frequently visiting emergency room of the hospital with acute symptoms such as acute pain crisis and shortness of breath. This is the reason that the emergency rooms of the hospital are frequently receiving SCD patients with serious complications which decreases quality of life and morbidity among the affected people. The present study was done to review the patients with sickle cell disease and attending the emergency room of AlJaffar general hospital which is situated in the eastern part of Al Ahsa with a catchment area of around 20 PHCs.
Material and Methods: This was a retrospective descriptive chart review study. The medical records of all the patients with SCD related problem attending the Emergency room of Al Jaffar hospital during the last 3 months were reviewed in this study. Study variables consisted of patients characteristics including age, sex, main symptoms for which the patient attended the ER. Any diagnosed sickle cell disease with complain of severe body pain localized or generalized attending the emergency room of the hospital were considered as suffering from VOC. The data were entered and analyzed by the SPSS version 21. Frequencies via descriptive studies were used for categorical variables, whereas means and standard deviation were obtained for continuous variables. Chi-square statistics were used to assess associations between variables followed by multivariable analysis. Data were calculated with theirrespective95% CI. A Pvalue less than 0.05 was considered statistically significant.
Result: The files of a total of one hundred and forty eight patients (N=148) of SCD who attended the ER of AlJaffar Hospital during the last 3 months with an average of 1.64 patients per day were studied. Almost fifty nine percent (N=87) of the patients were male. The mean age of the participants was 28.13 ±12.32 Std. Devyears. More than fifty five percent of the patients (N=82) attended due to severe body pain followed by twenty three percent (N=34) of those patients who attended due to leg pain. Seventeen percent (11.49%) of the patients attended with the complaint of SOB and chest pain while seven (4.73%), two (1.35%) and six (4.06%) patients were having complains with shoulder pain, hip joint pain and back pain respectively.
More than eighty eight percent of the participants presented with vasculo occlusive complication (VOC) of sickle cell disease while minority of the patients (11.49%) with more severe complication of Acute Chest complication. The majority of them (74.07%) had clinical and radiographic findings consistent with AVN of the hip joint while 11.11% and 7.4% each had acute vascular necrosis in knee joint, vertebrae and shoulder joint respectively. As far as the treatment in ER is concerned majority of the patients (62.8%, N=87) were treated With IV Paracetamol + Fentanyl + Tramadol followed by 31.8% of the patients who were treated with systemic NSAID. Only 5.4% (N=14) of the patients were treated with Morphine. The likelihood of VOC was significantly more among females (Adj. OR: 2.1; 95% CI 1.02- 4.7)and ACS was significantly less among the female (Adj. OR: 0.72, 95% CI 0.30-1.2). The likelihood of acute vascular necrosis of hip joint was more among male (Adj. OR 1.80, 95% CI 0.45-4.0) while the likelihood of acute necrosis of vertebrae and shoulder was more among the females (Adj. OR .2.20, 95% CI 0.85-4.50).
Conclusion: Patients with an acute painful episode related to sickle cell disease frequently visited the emergency room of Al jaffar hospital.VOC was the most common cause of the painful episodes. Short term treatment with IV Paracetamol + Fentanyl + Tramadol had been very effective in the present study and patients were discharged in 48 hours of time on oral NSAID. However less dependency on morphinre has been reported in the present study
