Associations Between Pain Scores and Opioid Doses With Emergency Department Disposition and Return Visit Rates in Children With Sickle Cell Disease

Rapid treatment and frequent reassessment of pain are key components of treatment guidelines for acute sickle cell disease (SCD) pain. Few studies, however, report the associations between emergency department (ED) pain scores, number of ED opioid doses, receipt of an opioid prescription, ED visit disposition, or ED return visits. This seven-site retrospective cohort study analyzed 4983 ED visits by children with SCD pain using electronic health record data from the Pediatric Emergency Care Applied Research Network Registry. ED pain scores included initial, last, and change in scores (initial minus last), measured on a 0-10 scale. Dispositions of discharge and hospital admission were included. Modified Poisson regression and the Cochran-Armitage test of trend were used for analysis. The median (IQR) initial pain score was 8.0 (6-10); last pain score was 5.0 (2-8); and median decrease was 2.0 (0-5). In multivariable analysis, last pain score was the best predictor of disposition. For the return visit analyses, of the 2377 visits discharged at index ED visit, 29% returned within 14 days. Higher initial and last ED pain scores were associated with increased return visits. Children with no opioid discharge prescription and ≥3 ED opioid doses had a return visit rate of 36% compared to 22% if the child received an opioid prescription and only one ED opioid. Increasing discharge opioid prescriptions and targeting interventions for those who receive multiple ED opioid doses could decrease return visits.

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Publication Details

Journal
Pediatric Blood & Cancer
Published
2025-05-02
DOI
https://doi.org/10.1002/pbc.31750
Citations
1
Primary Topic
Hemoglobinopathies and Related Disorders
Type
article
Field-Weighted Citation Impact
1.63

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article

Associations Between Pain Scores and Opioid Doses With Emergency Department Disposition and Return Visit Rates in Children With Sickle Cell Disease

Keli D. Coleman, Irina Topoz, Allison A. King, Selena Hariharan et al.
1 citations
Pediatric Blood & Cancer
Hemoglobinopathies and Related Disorders
1.63
article

Associations Between Pain Scores and Opioid Doses With Emergency Department Disposition and Return Visit Rates in Children With Sickle Cell Disease

Keli D. Coleman, Irina Topoz, Allison A. King, Selena Hariharan, Blake Nielsen, Alexis A. Thompson, David C. Brousseau, Ana A. Baumann, Andrew Campbell, Lawrence J. Cook, Charles T. Quinn, Rachelle Nuss, Robert I. Liem, Morgan Wurtz, Anthony Villella, Kenneth McKinley, Angela M. Ellison, Amanda M. Brandow, Elizabeth R. Alpern, Warren D. Frankenberger, Claudia R. Morris
article en
1 citations

Abstract

Rapid treatment and frequent reassessment of pain are key components of treatment guidelines for acute sickle cell disease (SCD) pain. Few studies, however, report the associations between emergency department (ED) pain scores, number of ED opioid doses, receipt of an opioid prescription, ED visit disposition, or ED return visits. This seven-site retrospective cohort study analyzed 4983 ED visits by children with SCD pain using electronic health record data from the Pediatric Emergency Care Applied Research Network Registry. ED pain scores included initial, last, and change in scores (initial minus last), measured on a 0-10 scale. Dispositions of discharge and hospital admission were included. Modified Poisson regression and the Cochran-Armitage test of trend were used for analysis. The median (IQR) initial pain score was 8.0 (6-10); last pain score was 5.0 (2-8); and median decrease was 2.0 (0-5). In multivariable analysis, last pain score was the best predictor of disposition. For the return visit analyses, of the 2377 visits discharged at index ED visit, 29% returned within 14 days. Higher initial and last ED pain scores were associated with increased return visits. Children with no opioid discharge prescription and ≥3 ED opioid doses had a return visit rate of 36% compared to 22% if the child received an opioid prescription and only one ED opioid. Increasing discharge opioid prescriptions and targeting interventions for those who receive multiple ED opioid doses could decrease return visits.

Pediatric Blood & CancerVol. 72(7)
Northwestern University (US), Children's Hospital of Wisconsin (US), Cincinnati Children's Hospital Medical Center (US), Lurie Children's Hospital (US), Nationwide Children's Hospital (US), Children's Hospital of Philadelphia (US), Children's National (US), Thomas Jefferson University (US), Emory University (US), Medical College of Wisconsin (US), Washington University in St. Louis (US), University of Utah (US), Children's Hospital Colorado (US), Center for Cancer and Blood Disorders (US), Children's Healthcare of Atlanta (US), University of Colorado Anschutz Medical Campus (US), University of Cincinnati Medical Center (US), University of Colorado Denver (US)
U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau
Good health and well-being
Openalex Percentile: Top 18%
Hemoglobinopathies and Related Disorders
1.63
DOIOpen Access PDFOpenAlex
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