RESUMEN
The painful crisis of sickle cell disease is a major cause of recurrent morbidity normally managed by hospital admission. The MRC Laboratories Sickle Cell Unit has been exploring possiblities of outpatient management and the experience in a day care centre over a one-year period (1/4/95 - 31/3/96) is reviewed. During this period 597 painful crises of sufficient severity to require narcotic analgesia among 292 patients with homozygous sickle cell (SS) disease received treatment. Attendances within a 7-day period were arbitrarily considered the same crisis and those separated by more than 7 days as separate crises. There were 146 (50 percent) males and ages ranged from 3.3 - 50.1 years. Single painful crises occurred in 169 patients, 2 crises in 54, 3 - 5 crises in 66, 6 - 9 crises in 9, and more than 9 crises in 4 patients. A cyclical model was found to fit both the monthly attendances and meteorological temperature data for the same period. Fever exceeded 39§C in 11 patients (3 acute chest syndrome, 1 Haemophilus influenza septicaemia, 1 infected leg ulcer; 6 had sterile blood cultures and no apparent cause other than painful crisis). By 3pm patients were given the option of admission or discharge. 25 patients (8.9 percent) with 30 crises were admitted to hospital and 267 patients (91.4 percent) with 567 crises were discharged with oral analgesia. It is proposed that outpatient management of painful crises is feasible, selected by the great majority of patients, and can markly reduce demands on inpatient services. (AU)