{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T17:56:12Z","timestamp":1761155772844},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,3,19]],"date-time":"2014-03-19T00:00:00Z","timestamp":1395187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Describe the treatment of patients with vaso\u2010occlusive crises (<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>) in a Brazilian emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) and the successful switch from intravenous to oral morphine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>We analyzed records of 315 patients with sickle cell disease using two different protocols for pain: one in March 2010 prescribing intravenous morphine every 4\u00a0h throughout their stay, and another in March 2011 and 2012 prescribing one initial dose of intravenous morphine followed by equianalgesic doses of oral morphine every 4\u00a0h. Patients were triaged into three groups: mild, moderate, and severe <jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>. The mild group was treated within 1\u00a0h after triage, the moderate within 30\u00a0min and the severe was treated immediately. Patients whose pain was not relieved within 6\u00a0h after the first dose of morphine were transferred into a different holding area of the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> where they continued to receive the same treatment for 48\u00a0h after which they were hospitalized if still in pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The number of patients who stayed &lt;24\u00a0h in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> increased significantly from 63 in 2010 to 87 in 2012, and the number of admissions decreased from 26 in 2010 to 10 in 2012. The incidence of acute chest syndrome decreased from 8.5% in 2010 to 1.9% in 2012.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients treated with oral morphine stayed a shorter time in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>, had more pain relief, were admitted less frequently, and had less acute chest syndrome. These differences may be due to environmental, cultural, psychological, and pharmacogenetic factors.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ejh.12293","type":"journal-article","created":{"date-parts":[[2014,2,27]],"date-time":"2014-02-27T07:56:41Z","timestamp":1393487801000},"page":"34-40","source":"Crossref","is-referenced-by-count":12,"title":["Treatment of the acute sickle cell vaso\u2010occlusive crisis in the Emergency Department: a Brazilian method of switching from intravenous to oral morphine"],"prefix":"10.1111","volume":"93","author":[{"given":"Jessica","family":"Campos","sequence":"first","affiliation":[{"name":"Clinical Hematology Division Instituto de Hematologia Arthur de Siqueira Cavalcanti \u2013 HEMORIO Rio de Janeiro Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clarisse","family":"Lobo","sequence":"additional","affiliation":[{"name":"Clinical Hematology Division Instituto de Hematologia Arthur de Siqueira Cavalcanti \u2013 HEMORIO Rio de 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