期刊名称：General Internal Medicine and Clinical Innovations
电子版ISSN：2397-5237
出版年度：2016
卷号：1
期号：4
页码：59-61
DOI：10.15761-GIMCI.1000118
语种：English
出版社：Open Access Text
摘要：Labs are routinely ordered for patients admitted to the emergency department (ED) for uncomplicated Vaso Occlusive Events (VOE), however, there are no “standard” screening practices. The objective of this study was to evaluate the utility of one measure, reticulocyte count, in cases of uncomplicated VOE in Sickle Cell Disease (SCD). To assess the value of screening reticulocyte count we completed a retrospective database and chart review of patients with SCD presenting in the ED with pain suggestive of VOE. The setting for the study was an urban tertiary hospital with an active sickle cell program including a dedicated Sickle Cell Center (SCC). SCD patients presenting in the ED are treated using a standardized clinical pathway (SCP). Over the eight-year study period, 346 patients with SCD presented in the ED with VOE pain and 1509 patient encounters were included in the study. No participants presented with reticulocytopenia as identified by the initial reticulocyte count. This study demonstrates that a reticulocyte count is not necessary in patients presenting with uncomplicated VOE without the presence of other complicating factors. Our results support a focused testing strategy utilizing reticulocyte count evaluation in complicated SCD presentations only. The results obtained in this study are in concordance with similar studies. The strength of this study lies in the long duration of evaluation and the use of a clinical pathway to screen for high-risk criteria in a prospective fashion. Even more restrictive testing strategies might be employed to further streamline the management of low risk patients, improve ED workflow processes, and reduce costs. One such strategy may be earlier evaluation of the serum hemoglobin via point-of-care testing at triage; however, further studies are needed to examine the reliability and practicality in applying such an approach.
