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Abstract
Objective: To determine if intravenous morphine is associated with acute chest syndrome (ACS) in children with homozygous for hemoglobin S sickle cell disease (SCD) hospitalized with acute pain.
Methods: Health records of patients with homozygous for hemoglobin S SCD aged 2 to 18 years hospitalized with acute pain were reviewed. Patients developed ACS at least 12 hours after emergency department triage; controls did not develop ACS. Survival analyses were performed.
Results: There were 38 cases and 45 randomly selected controls. The mean hourly dose of morphine 1, 2, and 3 hours before ACS and cumulative mean morphine dose up to 5 hours before ACS were significantly associated with ACS (P < .05). Adjusted analysis showed that 1 hour before ACS, the mean morphine dose was significantly higher in cases (40 µg/kg) compared with controls (34 µg/kg), and the risk of ACS increased by 23% for each additional 10 µg/kg of morphine received (P = .02).
Conclusions: We recommend close observation for ACS in hospitalized patients with SCD who are receiving morphine.
- ACS
- acute chest syndrome
- CI
- confidence interval
- ED
- emergency department
- HR
- hazard ratio
- HbSS
- homozygous for hemoglobin S
- IV
- intravenous
- PCA
- patient-controlled analgesia
- PMIU
- pediatric medicine inpatient unit
- SCD
- sickle cell disease
- Copyright © 2013 by the American Academy of Pediatrics
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