Opioid Timeliness in Sickle Cell Disease
Does more timely administration of analgesia prevent hospitalization in children presenting to the ED with vaso-occlusive pain? That's what these authors aimed to find in this study from the PECARN network. They looked at nearly 10,000 encounters for uncomplicated sickle cell pain crises (not acute chest, splenic sequestration, priapism, etc) over 2 years and evaluated whether or not the patient was admitted based on how quickly the first and second dose of opioid analgesia was given.
What did they find? In short, the quicker the first and second dose were given, the less likely the patient was to require admission. First dose within 60 minutes led to a 15% reduction in admission. When the second dose was given quickly after the first (between 30 and 60 minutes), even if the first was delayed, it also led to decreased odds of hospitalization. The patients least likely to require admission had the first dose within 60 minutes and the second dose within 30 of the first, with an OR of 0.62. Notably, this was opioid analgesia given via any route except oral (IV, IN, IM).
Bottom Line: When patients with sickle cell disease present with uncomplicated pain crisis, early parenteral opioid analgesia leads to decreased likelihood of admission. Make sure to see these patients quickly, and re-evaluate them to make sure their pain is well controlled or address it if not!
What did they find? In short, the quicker the first and second dose were given, the less likely the patient was to require admission. First dose within 60 minutes led to a 15% reduction in admission. When the second dose was given quickly after the first (between 30 and 60 minutes), even if the first was delayed, it also led to decreased odds of hospitalization. The patients least likely to require admission had the first dose within 60 minutes and the second dose within 30 of the first, with an OR of 0.62. Notably, this was opioid analgesia given via any route except oral (IV, IN, IM).
Bottom Line: When patients with sickle cell disease present with uncomplicated pain crisis, early parenteral opioid analgesia leads to decreased likelihood of admission. Make sure to see these patients quickly, and re-evaluate them to make sure their pain is well controlled or address it if not!
