Length of stay and appropriate pain management for sickle cell patients are complicated by several features of this disease. First, assessment of pain is necessarily subjective and there do not yet exist objective and relaible methods of accurately assessing and quantifyong the pain experience. As a result, physicians must rely on the patient’s self-reporting. Secondly, some proportion of sickle cell patients do not reliably assess their pain. This may be due to drug seeking behavior in a minority, inability to distinguish acute and chronic pain, or secondary gain for prolonging hospitalization. Consequenlty there is no reliable method to guide what is appropriate legth of stay (LOS).
National Institute for Health and Clinical Excellence (NICE). Sickle cell acute painful episode: management of an acute painful sickle cell episode in hospital. London (UK): National Institute for Health and Clinical Excellence (NICE); 2012 Jun. 25 p. (NICE clinical guideline; no. 143).
Ballas, Samir K. Current Issues in Sickle Cell Pain and Its Management Hematology 2007 2007: 97-105
Rees DC, Olujohungbe AD, Parker NE, Stephens AD, Telfer P, Wright J. Guidelines for the management of the acute painful crisis in sickle cell disease. British Journal of Haematology 2003;120(5):744-52.