How long should an average sickle cell crisis last?

Date First Published:
June 16, 2006
Last Updated:
July 14, 2006
Report by:
Sheena McCullough, Medical student (MRI)
Three-Part Question:
In [a patient with a painful sickle cell crisis] how [much time should pass] before [the crisis resolves].
Clinical Scenario:
A 39 year old man with sickle cell disease presents to the emergency department with a 24hr history of pain in his arms and legs. His pain is consistent with his usual painful crisis. You wonder to yourself how long on average does a painful crisis last .
Search Strategy:
MEDLINE (1966 to present)
EMBASE (1988 to present)
Search Details:
OVID: [sickl$.mp.] AND [exp Anemia/ or anaemia$.mp] OR [exp Anemia, Sickle Cell/ or sickle cell crisis.mp.] AND [painful.mp. and crisis.mp.] AND [exp "Length of Stay"] limited to English language and humans.
Outcome:
This search yielded 56 articles. Bibliographic references found in these articles were also examined to identify related literature. Only original research articles were included. Three articles directly addressed the question. The Cochrane library was also searched but no relevant results were found. Other mesh terms were also searched such as "time factors" but yielded no more relevant results.
Relevant Paper(s):
Study Title Patient Group Study type (level of evidence) Outcomes Key results Study Weaknesses
Sickle cell anemia day hospital: an approach for the management of uncomplicated painful crises Lennette, J 2000 USA 144 sickle cell anaemia patients who sought treatment for acute painful crisis of varying frequency amounting to 2552 visits to the day hospital over 5years. Survey Length of stay in hospital The average length of stay (LOS) in the day hospital was 4.5hrs (range 2 to 7hrs) while the average LOS in the emergency department was 13hrs (range 11mins to 90hrs) The aim of the study was not clearly stated.
No mention of any ethical approval.
Assessment of painful episode frequency in sickle-cell disease Westerman, M 1997 USA 15 adults, aged 21 years and older, with sickle cell disease. Survey Length of stay in hospital 33% (on average) of total episodes were shorter lasting(less than 48hrs). 20% of these total episodes were 24hr episodes and 13% were 48 hr episodes. Small sample size
Selection bias
Hospital readmission for adult acute sickle cell painful episodes: frequency, etiology and prognostic significance Ballas, S et al 2005 USA 182 adult patients with SS were followed from January 1998 through to December 2002 Prospective cohort longitudinal observational study Length of stay in hospital The average length of stay was 7.6 days in hospital. small sample size
Author Commentary:
Most painful episodes are managed at home with oral analgesia and fluids by the patient. The evidence suggests that the sickle cell crisis is very variable both in the severity of pain, the location and the time period for which the crisis lasts. It has been shown that the crisis episode may last from a few minutes to weeks. Fortunately crisis which are severe enough to require hospitalisation are few and far between. Data from one study indicated that the average rate was 0.8 episode per patient per patient-year. [2]For most patients the painful crisis that does not require hospitalisation resolves within five to seven days. However in those requiring hospitalisation for severe pain the crisis may persist for weeks to months.[1]
Bottom Line:
The time length of a crisis is very variable, but it usually last between 5 and 7 days.
References:
  1. Lennette, J. Sickle cell anemia day hospital: an approach for the management of uncomplicated painful crises
  2. Westerman, M. Assessment of painful episode frequency in sickle-cell disease
  3. Ballas, S et al. Hospital readmission for adult acute sickle cell painful episodes: frequency, etiology and prognostic significance
  4. Platt OS et al. Pain in sickle cell disease. Rates and risk factors
  5. Shapiro BS. The management of pain in sickle cell disease.