Trusted Resources: Evidence & Education
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Comparing Sickle Cell Disease Acute Pain Management in the Pediatric and Adult Emergency Department
source: American Society of Pediatric Hematology/Oncology
Vasoocclusive pain leading to frequent emergency department visits and hospital admissions are the hallmark of sickle cell disease (SCD). Adolescents with SCD are known to have higher rates of emergency department (ED) visits and transition to adult care are associated with significant challenges. Adults with SCD have reported higher rates of stigmatization and perception of neglect when receiving care.
Assess if there is a difference in the number of visits, admission rate, analgesia choice, and time to analgesia between pediatric and adult ED visits for patients aged 10-30.
Retrospective chart review of emergency department visits of 10-30-year-old patients with sickle cell disease between Jan 2015 to Jun 2018 at one institution. Visits for vasoocclusive pain were selected based on encounter location, chief complaint and chart review audit. We excluded two adult patients that had significantly more visits than anyone else. Differences between the pediatric and adult ED care were compared via t-test. Pain management was evaluated based on 2014 National, Heart, Lung, and Blood Institute guidelines which recommend opiate analgesia within 60 minutes as first line therapy.
There were 43 pediatric ED visits by 21 unique patients resulting in 21 inpatient admissions. There were 177 adult ED visits by 67 unique patients resulting in 77 inpatient admissions. From the 27 pediatric ED encounters that utilized opiates, 52% (14) received opiates within 60 minutes of arrival. From the 148 adult ED encounters that utilized opiates, 47% (70) received opiates within 60 minutes of arrival. Median time to opiate analgesia was 70 minutes in the adult ED versus 56 minutes in the pediatric ED. 33% of pediatric ED encounters used nonopiate therapy an hour prior to opiate therapy compared to only 16% of adult ED encounters.
Despite shorter median time to opiate analgesia, pediatric ED encounters were significantly more likely to utilize nonopiate analgesia prior to opiate analgesia. However, approximately half of patients in both EDs did not receive analgesia within the 60 minutes recommended by guidelines. While there is some practice variation, this study does not demonstrate significant difference in time to analgesia between adult and pediatric EDs as previous studies have demonstrated.
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