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Impact of emergency department care on outcomes of acute pain events in children with sickle cell disease. Am J Hematol 2016 12;91(12):1175-1180 PMID: 27517842

Pubmed ID

27517842

DOI

10.1002/ajh.24534

Abstract

The impact of emergency department (ED) treatment on outcomes of sickle cell disease (SCD) acute pain hospitalizations is not well described. We investigated whether length of stay (LOS) and change in health-related quality of life (HRQL) are affected by initial opioid dose and time to administration. We conducted secondary analyses of data from the randomized-controlled Magnesium for children in Crisis (MAGiC) trial. The primary outcome was LOS. Secondary outcome was change in HRQL, assessed using PedsQL SCD Pain and Hurt and Pain Impact Domains measured in ED and at discharge. Independent variables were (1) time to first IV opioid, (2) total initial opioid dose (mg/kg/hr of morphine equivalents administered between ED and first study drug), and (3) Time to first oral opioid. Spearman correlations determined the associations with LOS. Using two-sample t-tests, we compared mean change in HRQL scores between IV opioid initiated within 60 and >60 min, opioid doses in the highest and lowest tertiles, and oral opioid initiated within 24 and >24 hr. Two hundred and four patients participated at 8 sites. Mean (SD) age was 13.6 (4.7) years. Earlier initiation of oral opioids was strongly correlated with shorter LOS (r = 0.61, P < 0.01). Higher initial opioid dose was weakly correlated with longer LOS (r = 0.34, P < 0.01). Higher initial opioid doses (6 vs -2.2; P = 0.01) and oral opioids initiated within 24 hr (5.7 vs -1.7, P = 0.04) were associated with larger mean change in HRQL at discharge. Prospective trials evaluating the impact of ED care on outcomes of pain hospitalizations could improve SCD pain treatment. Am. J. Hematol. 91:1175-1180, 2016. © 2016 Wiley Periodicals, Inc.

Author List

Brandow AM, Nimmer M, Simmons T, Charles Casper T, Cook LJ, Chumpitazi CE, Paul Scott J, Panepinto JA, Brousseau DC

Authors

Amanda Brandow DO Associate Professor in the Pediatrics department at Medical College of Wisconsin
David Brousseau MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Julie A. Panepinto MD, MSPH Professor in the Pediatrics department at Medical College of Wisconsin
John Paul Scott MD Professor in the Pediatrics department at Medical College of Wisconsin




Scopus

2-s2.0-84984821843   8 Citations

MESH terms used to index this publication - Major topics in bold

Acute Pain
Adolescent
Analgesics, Opioid
Anemia, Sickle Cell
Child
Child, Preschool
Emergency Medical Services
Emergency Service, Hospital
Female
Humans
Length of Stay
Male
Prospective Studies
Quality of Life
Time-to-Treatment
Treatment Outcome
Young Adult
jenkins-FCD Prod-310 bff9d975ec7f2d302586822146c2801dd4449aad