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Triage Status is a Predictor of Higher Emergency Department Utilization Among Traumatically Injured Patients with Sickle Cell Disease

Parchuri, Ektha (2023) Triage Status is a Predictor of Higher Emergency Department Utilization Among Traumatically Injured Patients with Sickle Cell Disease. Master Essay, University of Pittsburgh.

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Introduction: Sickle cell disease (SCD) impacts one in 500 African Americans and is associated with vaso-occlusive events (VOE), leading to severe complications if unmanaged. Effective pain management in emergency settings is often delayed due to stigma and limited resources. Given similar inflammatory responses characterizing both VOE and traumatic injury, this study is the first to examine whether traumatic injury aggravates VOE-related outcomes and pain management needs.
Methods: A retrospective chart review was conducted from an SCD clinic in Western Pennsylvania from 2000-2021. SCD and injury status was determined using ICD-9/10 data. Patients were sorted into three treatment groups based on injury hospital management: 1) neither trauma triage nor ICU admission (“early discharge”), 2) triage but no ICU (“triage only”), and 3) “triage-ICU”. Primary outcomes included pre/post-injury annual frequency of VOE events and ED length of stay (LOS) for VOE; secondary outcomes included time from injury to first VOE.
Results: A total of 356 patients with SCD from 2000-2021 were identified; 55 patients with prior traumatic injury were included. No significant increase in annual frequency of VOE or ED LOS for VOE post-injury. Triage only individuals experienced a significant increase in ED LOS for first VOE (MD= 61.3 hours, p=0.038). All triaged-injured SCD patients experienced a significant post-injury increase in LOS for VOE (MD=34.06 hours, t=2.205, p=0.023), compared to non- triaged (MD = 0.01, t=2.006, p=0.997). Kaplan-Meier log-rank test revealed early discharge individuals experienced a VOE event within 2.93 days of injury, followed by triage-ICU individuals at 52.375 days and triage-only individuals at 100.16 days (p=0.0058). No-ICU patients experienced a VOE event in less than 1 day, compared to those ICU patients at 52.16 days (K2 log rank = 0.9, p=0.33). Hazard rate of VOE events was affected by trauma triage (p=0.06).
Conclusions: Triage status was a significant predictor in poor VOE outcomes, resulting in increased annual VOE events and longer ED length of stay for VOE. It is in the best interest of public health experts and of public health significance to develop specific triage protocols for ED management of the injury in SCD patients.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Parchuri, Ekthaekp17@pitt.eduekp170000-0003-3862-3919
ContributionContributors NameEmailPitt UsernameORCID
Thesis advisorJonassaint, Charlescjonassaint@pitt.educjonassaintUNSPECIFIED
Committee ChairPacella-LaBarbara, Mariamlp94@pitt.edumlp94UNSPECIFIED
Committee ChairGlynn, Nancyepidnwg@pitt.eduepidnwgUNSPECIFIED
Date: 17 May 2023
Date Type: Completion
Submission Date: 24 April 2023
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 40
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: sickle cell, traumatic injury, emergency medicine, hematology, surgery
Date Deposited: 17 May 2023 16:04
Last Modified: 17 May 2023 16:04


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