160: Evaluation of an Oral Morphine Protocol in Early Treatment of Acute Pain Crisis in Sickle Cell Patients in the Outpatient Setting
Bibliographic record
Abstract
Sickle cell vaso-occlusive crisis (VOC) is one of the most frequent causes of emergency visit, and admission in children with this condition. To evaluate wheter the implementation of an oral morphine protocol has led to improved care of sickle cell disease (SCD), translated by a reduced hospitalization rate, comparing the cohort of SCD patients presenting to the ED with VOC pre and post implementation. We also aimed at evaluating if the oral route was favored for morphine administration, and if this led to quicker time of administration. Retrospective chart review of patients with SCD followed in the hematology clinic at CHU Ste-Justine, who presented to the ED with VOC requiring opioids, in the year pre (January–June 2012) and post (January–June 2014) implementation of the oral morphine protocol. Patients with a diagnosis of VOC during the study periods were selected in the ED database. The primary objective was to evaluate the hospitalization rate before and after the implementation of the protocol. The rate of oral administration as well as the delay of administration of the first opiate dose after triage pre and post-implementation were calculated. We estimated that 35 patients per arm would be sufficiently powered to detect at least a 30% rate reduction of admissions, with a power of 80% and a significance of 0.05. Over the two periods, a total of 67 patients (35 pre and 32 post) were included: the mean age was 9.0±4.1 years. A total of 33/35 (94%) patients were admitted in pre vs 16/32 (50%) in post: a difference of 44% (95% CI 23, 61). None of the two patients discharged in pre returned within 72 hours of VOC, compared to 2/16 (12%) in post: a difference of 12% (95% CI −36, 54). In pre, 5/32 (16%) patients received their first dose orally compared to 18/32 (54%) in post: a difference of 41% (95% CI 17, 58). Surprisingly, there was no difference in the delay of administration of the first opiate dose after triage: median of 88 min (IQR 67, 119) in pre vs 83 min (IQR 59, 112) in post (difference of 5 min [95% CI −14, 27]). This study validates the use of our oral morphine protocol for the treatment of sickle cell VOC, by showing a significant reduction in hospitalization rates. Although a reduction in time to first opiate dose was not seen in the post protocol period favoring the oral route, it decreased the number of painful IV procedures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".