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Practice Guidelines

Management of an acute painful sickle cell episode in hospital: summary of NICE guidance

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4063 (Published 27 June 2012) Cite this as: BMJ 2012;344:e4063

Re: Management of an acute painful sickle cell episode in hospital: summary of NICE guidance

This welcomed and timely NICE guidance[1][2] has the potential to improve the care of sickle cell patients. It is disappointing the opportunity of advocating incentive spirometry as a effective simple and cheap (different brands available for as little as £14) non-pharmacological intervention was missed, given that up to 54% of patients currently receive it as standard care for their in-patient admission.[3] It involves awake patients taking 10 maximal inspirations every two hours.

Randomised data in those presenting with chest or back pain demonstrates an absolute risk reduction of 36.8% (95% CI 12.5-61.2%) for pulmonary complications (associated with the development of acute chest syndrome), and reduced hospitalisations.[4] Inclusion within this high-profile guideline would have improved suboptimal or inconsistent utilisation[3], and as the NNT is just 2.7 (95% CI 1.6-8.0) would have immediate benefit to both patients and budgets.

References
[1] Management of an acute painful sickle cell episode in hospital: summary of NICE guidance. Gillis VL, Senthinathan A, Dzingina M, Chamberlain K, Banks E, Baker MR, Longson D; on behalf of the Guideline Development Group. BMJ. 2012;344:e4063
(doi: 10.1136/bmj.e4063)

[2] National Institute for Health and Clinical Excellence. Sickle cell acute painful episode: management of an acute painful episode in hospital. (Clinical guideline 143.) 2012. http://guidance.nice.org.uk/CG143.

[3] Miller ST, Kim HY, Weiner D, Wager CG, Gallagher D, Styles L, Dampier CD; Investigators of the Sickle Cell Disease Clinical Research Network (SCDCRN). Inpatient management of sickle cell pain: a 'snapshot' of current practice. Am J Hematol. 2012;87:333-6.
(doi: 10.1002/ajh.22265)

[4] Bellet PS, Kalinyak KA, Shukla R, Gelfand MJ, Rucknagel DL. Incentive spirometry to prevent acute pulmonary complications in sickle cell diseases. N Engl J Med. 1995;333:699-703.

Competing interests: No competing interests

20 July 2012
Amit Patel
SpR in Haematology & Intensive Care Medicine
Imperial College London; Imperial College Healthcare NHS Trust
MRC Clinical Sciences Centre, Hammersmith Hospital, Du Cane Road, London, W12 0NN