The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain. Pediatr Blood Cancer 2020 Sep;67(9):e28268
Date
07/03/2020Pubmed ID
32614150Pubmed Central ID
PMC7674235DOI
10.1002/pbc.28268Scopus ID
2-s2.0-85087314028 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
INTRODUCTION: The National Heart, Lung, and Blood Institute guidelines for sickle cell disease (SCD) pain crisis management recommend opioids within 60 minutes of emergency department (ED) registration and every 30 minutes thereafter until acute pain is managed. These guidelines are based on expert opinion without published, supporting data.
OBJECTIVE: To evaluate the association between timely ED opioid administration and hospitalization rates in children with SCD.
METHODS: Retrospective cohort of children presenting to a children's hospital ED with SCD pain between January 1, 2014, and April 30, 2018. Visits were extracted using ICD codes, chief complaints, and receipt of at least one opioid, and then reviewed to confirm the visit was an uncomplicated pain crisis. The primary outcome was hospitalization, yes or no. Generalized estimating equations were used to determine adjusted odds of hospitalization for the timely administration of initial and second doses of opioids.
RESULTS: Of the 902 eligible visits, 368 (40.8%) resulted in hospitalization. The mean (SD) age was 11.9 (± 5.2) years. The first opioid was administered within 60 minutes of arrival in 601 (66.6%) visits. The second opioid was administered within 30 minutes of the first in 84 (12.3%) visits. Receipt of the first opioid within 60 minutes of arrival was not associated with decreased hospitalization (1.30 [0.96-1.76]). However, receipt of the second dose within 30 minutes of the first was associated with decreased hospitalization (0.56 [0.33-0.94]).
CONCLUSION: This study suggests an association between children with SCD receiving a second dose within 30 minutes of the first opioid dose and decreased hospitalizations.
Author List
Muslu CS, Kopetsky M, Nimmer M, Visotcky A, Fraser R, Brousseau DCAuthors
Raphael Fraser PhD Assistant Professor in the Medicine department at Medical College of WisconsinAlexis M. Visotcky Biostatistician III in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Acute PainAdolescent
Analgesics, Opioid
Anemia, Sickle Cell
Child
Drug Administration Schedule
Emergency Service, Hospital
Female
Humans
Male
Pain Management
Retrospective Studies
