Table 1.
ASH’s acute neurological deficits recommendation 4.12  
For children or adults with SCD and acute neurological deficits, including transient ischemic attack, the ASH systematic review panel guidelines recommend prompt blood transfusion. Aligned with recommendations for the general population, the ASH special panel similarly recommends prompt blood transfusion for children or adults with SCD and acute neurological deficits held in custody. The transfusion should be given immediately upon recognizing symptoms, without delay, ideally within 2 hours of acute neurological symptom presentation. Acquiring imaging should not delay blood transfusion in the setting of new focal neurological deficits suggestive of a stroke or a transient ischemic attack. The type of transfusion (simple, modified exchange, or apheresis) depends on individual patient factors and local transfusion resources (strong recommendation).2  
ASH special panel implementation strategy

  • If the patient has acute focal neurological findings, facility personnel should immediately refer the patient to the nearest medical center for emergency care, either by calling 911 or by providing prompt (ie, within 1 hour) nonmedical transport to the ED, where timely evidence-based medical care for acute stroke treatment for individuals with SCD can be delivered.

  • A correctional facility placement is prioritized to a location geographically close to a medical center equipped to care for a patient with SCD. Access to a higher level of care can be limited in rural areas.

  • Prioritized admission to precontracted correctional acute health facilities with SCD expertise.

 
ASH’s acute pain recommendation 1a1 
For adults and children with SCD presenting to an acute care setting with acute pain related to SCD, the ASH systemic review panel guideline panel recommends rapid (within 1 hour of ED arrival) assessment and administration of analgesia with frequent reassessments (every 30-60 minutes) to optimize pain control.1  
The ASH special panel implementation strategy for children and adults in custody

  • Immediate notification and assessment, including vital signs and pulse oximetry assessment, should be conducted, with prompt notification and involvement of the licensed medical personnel on site.

  • If no licensed medical staff is available on site, the patient should be evaluated by telemedicine or emergency medicine services or transferred promptly, with the assistance of security staff, to a medical facility for assessment.

  • If the acute vaso-occlusive pain event is complicated, prompt referral to a medical facility for a full assessment and further management is required.

 
ASH’s acute pain recommendation 21 
For adults and children with mild acute pain related to SCD, the ASH guideline panel suggests a short course (5-7 days) of NSAIDs (eg, ibuprofen or naproxen but not ketorolac [see “ASH’s systematic review recommendation for acute pain management”]). For more severe pain, follow ASH guidelines. 
ASH special panel implementation strategy

  • Oral hydration and nutrition

  • Heat therapy

  • Mindfulness strategies

  • Distraction exercises

  • Communication access

  • Alternative activities

  • Incentives for positive behavior

  • Spiritual support

  • Private room

  • Avoid extreme cold or hot, humid conditions

 
ASH’s acute neurological deficits recommendation 4.12  
For children or adults with SCD and acute neurological deficits, including transient ischemic attack, the ASH systematic review panel guidelines recommend prompt blood transfusion. Aligned with recommendations for the general population, the ASH special panel similarly recommends prompt blood transfusion for children or adults with SCD and acute neurological deficits held in custody. The transfusion should be given immediately upon recognizing symptoms, without delay, ideally within 2 hours of acute neurological symptom presentation. Acquiring imaging should not delay blood transfusion in the setting of new focal neurological deficits suggestive of a stroke or a transient ischemic attack. The type of transfusion (simple, modified exchange, or apheresis) depends on individual patient factors and local transfusion resources (strong recommendation).2  
ASH special panel implementation strategy

  • If the patient has acute focal neurological findings, facility personnel should immediately refer the patient to the nearest medical center for emergency care, either by calling 911 or by providing prompt (ie, within 1 hour) nonmedical transport to the ED, where timely evidence-based medical care for acute stroke treatment for individuals with SCD can be delivered.

  • A correctional facility placement is prioritized to a location geographically close to a medical center equipped to care for a patient with SCD. Access to a higher level of care can be limited in rural areas.

  • Prioritized admission to precontracted correctional acute health facilities with SCD expertise.

 
ASH’s acute pain recommendation 1a1 
For adults and children with SCD presenting to an acute care setting with acute pain related to SCD, the ASH systemic review panel guideline panel recommends rapid (within 1 hour of ED arrival) assessment and administration of analgesia with frequent reassessments (every 30-60 minutes) to optimize pain control.1  
The ASH special panel implementation strategy for children and adults in custody

  • Immediate notification and assessment, including vital signs and pulse oximetry assessment, should be conducted, with prompt notification and involvement of the licensed medical personnel on site.

  • If no licensed medical staff is available on site, the patient should be evaluated by telemedicine or emergency medicine services or transferred promptly, with the assistance of security staff, to a medical facility for assessment.

  • If the acute vaso-occlusive pain event is complicated, prompt referral to a medical facility for a full assessment and further management is required.

 
ASH’s acute pain recommendation 21 
For adults and children with mild acute pain related to SCD, the ASH guideline panel suggests a short course (5-7 days) of NSAIDs (eg, ibuprofen or naproxen but not ketorolac [see “ASH’s systematic review recommendation for acute pain management”]). For more severe pain, follow ASH guidelines. 
ASH special panel implementation strategy

  • Oral hydration and nutrition

  • Heat therapy

  • Mindfulness strategies

  • Distraction exercises

  • Communication access

  • Alternative activities

  • Incentives for positive behavior

  • Spiritual support

  • Private room

  • Avoid extreme cold or hot, humid conditions

 
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