Lenght of stay and appropriate pain management for sickle cell patients are complicated by several features of this disease. First, assessment of pain is necessarily subjective and there do not yet exist objective and relaible methods of accurately assessing and quantifyong the pain experience. As a result, physicians must rely on the patient's self-reporting. Secondly, some proporion of sickle cell patients do not reliably assess their pain. This may be due to drug seeking behavior in a minority, inability to distinguish acute and chronic pain, or secondary gain for prolonging hospitalization. Concsequenlty there is no reliable method to guide what is appropriate legth of stay (LOS).
Ballas, Samir K. Current Issues in Sickle Cell Pain and Its Management Hematology 2007 2007: 97-105
Rees DC, Olujohungbe AD, Parker NE, Stephens AD, Telfer P, Wright J. Guidelines for the management of the acute painful crisis in sickle cell disease. British Journal of Haematology 2003;120(5):744-52.