Sickle Cell Disease (SCD) Visits to Emergency Departments (ED)
Between 1999 and 2007, approximately 197,333 sickle cell disease ED visits occurred each year.
Sickle cell disease (SCD) is an inherited blood disorder characterized by the production of an altered type of hemoglobin by those affected by the disease. When sickle cell hemoglobin deoxygenates while passing through blood vessels, it polymerizes and becomes fibrous-like causing the red blood cell to become rigid and change shape, appearing sickle shaped. The altered red blood cells can clog blood vessels resulting in lack of oxygen to tissues and causing pain. Repeated, unpredictable episodes of acute pain are a complication of sickle cell disease that affect a substantial number of patients with the disease.
Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a survey of hospital ED and outpatient visits, for the years 1999–2007 revealed estimates of approximately 1,475,000 (95% CI = 1,214,000, 1,736,000) and 1,776,000 (95% CI = 1,484,000, 2,068,000) emergency department visits made by patients with a primary or any diagnosis of SCD, respectively. The estimated yearly average number of emergency department visits by patients with any diagnosis of SCD was 197,333. ED visits by patients with SCD were identified using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes, and nationally weighted estimates were calculated.
Reasons for ED Visits
Reasons for ED visits included chest pain (11%*), other pain or unspecified pain (67%), fever/infection (6%), and shortness of breath/breathing problem/cough (5%) among other reasons. Substantial numbers of ED visits occur among persons with SCD. The most common reason for the ED visits is pain symptoms. The findings of this study can help to improve health services delivery and utilization among patients with SCD.
Characteristics of ED Visits
The mode of arrival for most emergency department visits by patients with SCD was walk-in (79%), followed by ambulance (14%; Table 1). The mode of arrival was walk-in for 87% of visits by patients aged 0–19 years, and 76% of visits by patients aged ≥20 years. The age groups with largest percentage of ED visits were 20-29 years and 30-45 years, and the age group with the fewest visits was >45 years.
The expected source of payment for emergency department visits by patients with SCD was private insurance, Medicaid/State Children's Health Insurance Program (SCHIP), Medicare, and other or unknown for 14%, 58%, 14%, and 15% of visits, respectively. Among visits by patients aged 0 –19 years, the expected source of payment was private insurance for 20% and Medicaid or SCHIP for 70%. Among visits by patients aged20 years, the expected source of payment was private insurance for 11%, Medicare for 19%, and Medicaid for 53%.
The percentage of visits indicated to be initial visit, follow-up visit, and unknown as to the episode of care were 66%, 23%, and 11%, respectively (Table 1). Among visits by patients aged ≥20 years, the episode of care was indicated as a follow-up visit for 27% of the visits. Approximately 29% of emergency department visits by patients with SCD resulted in hospital admission. This was 37% among visits by patients aged 0–19 years, and 26% among visits by patients aged ≥20 years. The difference by age group in the percentage admitted to the hospital came close to but did not reach significance (p=0.059).
*All statistics listed in this feature under Reasons for ED Visits and Characteristics of ED Visits have been rounded to the nearest whole number. Co statistics can be found in the charts on this page.
Yusuf HR, Atrash HK, Grosse SD, Parker CS, Grant AM. Emergency Department visits made by patients with sickle cell disease: a descriptive study, 1999-2007 [PDF - 100 KB]. Am J Prev Med 2010;38(4S):S536–S541.
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