FROM: http://www.cdc.gov/Features/dsSickleCell_ED_Visits/
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.
Data Source
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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