Dr Sadam Hussain,Dr Mumtaz Ahmad,Dr Rizwan Ullah
In United States there are approximately 100 000 individual suffering from sickle cell disease of which 40% are children. There are 18 000 hospitalizations and 75 000 hospitalization days annually for the children who experience sickle cell pain crises. Much of the morbidity of the disease is a result of recurrent pain crises, which often result in emergency department (ED) visits and hospitalizations and adversely affect quality of life 4-7. Despite advances in the management of other comorbidities of sickle cell disease, little has changed in the management of pain crises. Standard supportive therapy remains intravenous (IV) opioids and the judicious use of IV fluids. In acute sickle cell painful crises many several multicenter trials have been closed because of inadequate enrollment, making advancements in the field difficult. The primary factors in the initiation and prolongation of pain crises in sickle cell disease v Vasoconstriction and inflammation. The main limitation of the study was measurement of opioid use, rather than pain scores. Although the clinical utility of pain scores is clear, the variability in pain scores throughout the day and the criticism that the timing of opioid treatments could significantly affect timed pain scores resulted in our decision to focus our secondary outcome on pain medication use. Intravenous magnesium does not shorten LOS, lessen opioid use, or improve HRQL in children who require hospitalization for sickle cell pain crisis. Close collaboration between pediatric emergency medicine physicians and pediatric hematologists allows for the successful, efficient enrollment of large numbers of children in an acute intervention trial for children with sickle cell anemia.