Re: Management of an acute painful sickle cell episode in hospital: summary of NICE guidance
This welcomed and timely NICE guidance 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. 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. Inclusion within this high-profile guideline would have improved suboptimal or inconsistent utilisation, and as the NNT is just 2.7 (95% CI 1.6-8.0) would have immediate benefit to both patients and budgets.
 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
 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.
 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.
 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