Systematic review of emergency department management of vaso-occlusive episodes in adults with sickle cell disease

The objective of this systematic review was to characterize the management of vaso-occlusive episodes (VOEs) in adult patients with SCD in the emergency department (ED) via implementation of a protocol or pathway intended to improve patient care for VOE-related pain. A literature search was conducted spanning origin through May 31, 2023, using Embase, MEDLINE ALL, and International Pharmaceutical Abstracts databases. Primary literature reporting on adult patients with SCD in a SCD-specific pathway or protocol in an ED setting was included. Data extracted included report design characteristics, patient demographics, descriptors of the pathway/protocol, pain outcomes, and hospital length of stay. The Cochrane Risk of Bias 2.0 tool was used to assess risk-of-bias in randomized controlled trials (RCTs). The Risk of Bias for Non-Randomized Studies of Interventions was used to assess risk-of-bias in nonrandomized trials (NRTs). Certainty of evidence was assessed via the Grading of Recommendations, Assessment, Development, and Evaluations tool. Nine reports met eligibility criteria: 2 reports of 1 RCT and 7 observational NRTs. The RCT had low risk-of-bias; 5 NRTs had moderate risk-of-bias, 2 had serious risk-of-bias. Improvements in time to first opioid, pain scores, length of ED treatment time, overall treatment time (length of stay), and inpatient readmission improved with policies/protocols for the management of VOEs in the ED setting. These 5 outcomes had a moderate certainty of evidence. Institutions should consider implementing protocols or pathways to improve management of VOEs in the ED.