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Risk factors associated with increased emergency department utilization in patients with sickle cell disease: a systematic literature review

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Abstract

Sickle cell disease (SCD), a genetic disorder affecting up to 100,000 patients in the USA, impacts multiple organ systems. The emergency department (ED) is frequently utilized by patients with SCD who have severe pain from vaso-occlusive crises. The goal of this systematic literature review is to identify predictors for ED use among patients with SCD in the USA, as high ED reliance is not ideal because of the potential for discontinuity of care as well as higher costs. PubMed and Embase were searched for articles containing the keywords “sickle cell disease” AND (“emergency” OR “acute care”) AND (“utilization” OR “health care”) published between 2000 and 26 September 2019. A total of 26 publications were identified meeting the following inclusion criteria: report of ED or acute care clinic use; report of health care utilization for SCD; and report of ED visits independent of hospital admission, ED revisits, inpatient care visits, and SCD care unit visits. Articles unavailable in English or those focused on populations outside the USA were excluded. Of the 26 articles included, 4 were prospective and the remainder were retrospective. Qualitative analysis of the articles revealed a higher rate of ED utilization among adults than children, patients with public insurance than private insurance, and patients with more comorbidities, complications, or pain. Age and pain levels were both commonly cited as predictors of ED utilization. Additional prospective and interventional studies are needed to further define predictors of ED utilization and to uncover treatments that decrease ED visits.

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Data are available upon request from corresponding author.

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Acknowledgments

Editorial support in the preparation of this manuscript was provided by Phase Five Communications, supported by Novartis Pharmaceuticals Corporation.

Funding

This study was sponsored by Novartis Pharmaceuticals Corporation.

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Authors and Affiliations

  1. Cardeza Foundation for Hematologic Research, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1020 Locust Street Suite 394, Philadelphia, PA, 19107, USA

    Samir K. Ballas

  2. Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Emory Healthcare, Atlanta, GA, USA

    Carlton Dampier

  3. AFLAC Cancer and Blood Disorders Center, Atlanta, GA, USA

    Carlton Dampier

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  1. Samir K. Ballas
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  2. Carlton Dampier
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Contributions

SKB and CD independently performed the literature search and agreed on the final study selection. Both authors extracted data from the selected studies. They also assessed the quality of the included studies and performed a cross-check for data accuracy. Both authors contributed to the writing of the manuscript, and both authors approved the final manuscript.

Corresponding author

Correspondence to Samir K. Ballas.

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Conflict of interest

Dr. Samir K. Ballas has served on the speakers’ bureau for Novartis Pharmaceuticals Corporation and has received honoraria from Novartis Pharmaceuticals Corporation. Dr. Carlton Dampier has received research funding from the Katz Foundation, the National Institutes of Health-National Institute of Child Health and Human Development and National Center for Advancing Translational Sciences, Merck & Co., Micelle BioPharma, Inc., Novartis Pharmaceuticals Corporation, and Pfizer Inc. He has been a consultant for Epizyme, Inc., Global Blood Therapeutics, Inc., Hilton Publishing Company, Ironwood Pharmaceuticals, Inc., Micelle BioPharma, Inc., Modus Therapeutics AB, Novartis Pharmaceuticals Corporation, and Pfizer Inc. He has also served on advisory boards for Micelle BioPharma, Inc., Novartis Pharmaceuticals Corporation, and Pfizer Inc.

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This article does not contain any studies with human participants or animals performed by either author.

Additional information

Previously presented

Portions of this manuscript were presented in an abstract and poster at the Foundation for Sickle Cell Disease Research (FSCDR) 13th Annual Sickle Cell Disease Research & Educational Symposium; 7–9 June 2019, Fort Lauderdale, FL, USA. Ballas SK, Dampier C. Systematic Review of Risk Factors Associated With Increased Emergency Department Utilization in Patients With Sickle Cell Disease in the United States.

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Ballas, S.K., Dampier, C. Risk factors associated with increased emergency department utilization in patients with sickle cell disease: a systematic literature review. Ann Hematol 99, 2483–2495 (2020). https://doi.org/10.1007/s00277-020-04205-0

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