Timely opioid treatment lowers hospitalizations in children with sickle cell disease

A new study has found that prompt administration of opioid pain relief in emergency departments reduces the likelihood of hospitalization for children with sickle cell disease, according to findings published in JAMA Pediatrics. 

Sickle cell disease (SCD) is a genetic blood disorder that can cause severe episodes of intense pain due to blocked blood flow. While national guidelines recommend prompt opioid treatment, this study is among the first to quantify the impact of timing on hospitalization rates, said Elizabeth Alpern, MD, MSCE, the George M. Eisenberg Professor and Vice Chair in the Department of Pediatrics at Northwestern University Feinberg School of Medicine, who was a co-author of the study. 

"There hasn't been prior work that shows if timely pain relief can impact important patient-centered outcomes like admission to the hospital," said Alpern, who is also head of the Division of Emergency Medicine at Ann & Robert H. Lurie Children's Hospital of Chicago. "If we can stabilize and treat patients' pain, they won't need to be admitted to the hospital, where they would miss school, their families would miss work, and it's disruptive to their lives." 

In the study, investigators analyzed data from the Pediatric Emergency Care Applied Research Network Registry, reviewing over 9,000 emergency department (ED) visits by 2,538 children under the age of 19 between 2019 and 2021. The findings offer compelling evidence that faster pain management can lead to better outcomes for pediatric patients with SCD, said Jacqueline Corboy, MD, Assistant Professor of Pediatrics in the Division of Emergency Medicine at Northwestern University Feinberg School of Medicine, who was also a co-author of the study. 

We were able to statistically show that if patients receive a timely first dose of opioid medications and a timely second dose of opioid medications, we could drastically reduce the number of hospital admissions within this population. This is the first study that shows concrete evidence, so this is really important." 

Jacqueline Corboy, MD, Director Of Quality, Division of Emergency Medicine at Lurie Children's

The study focused on two key time intervals: the time from ED arrival to the first opioid dose, and the time between the first and second doses. Children who received their first dose within 60 minutes of arrival were less likely to be hospitalized. The odds of hospitalization dropped even further when the second dose was administered within 30 minutes of the first. 

The combination of a first dose within one hour and a second dose within 30 minutes was associated with a reduction in hospitalization odds compared to less timely treatment, according to the study. Even when the second dose was delayed up to 60 minutes, timely first-dose administration still showed a protective effect. 

Alpern and Corboy said they hope the results will inform future clinical guidelines and improve care standards for children with SCD nationwide. 

"Our next steps are to continue to improve the processes that we have through the ED and work collaboratively with our inpatient partners, nurses and paramedics. We want to ensure that everybody's included as we implement these quality initiatives to improve care for our patients," Corboy said. 

The study was a collaborative effort among 12 pediatric hospitals, Alpern said, and data collected will be studied further as part of the Pediatric Emergency Care Applied Research Network. 

"We've utilized electronic health record data that's centralized and harmonized to see how this impacts operations and outcomes," said Alpern, who is Principal Investigator of the PECARN Registry. "The information that we have as a result helps us understand, in a much larger setting, how we can be effective." 

The study was supported by grant 1U01HL159850 from the National Heart, Lung, Blood Institute (NHLBI) and the Pediatric Emergency Care Applied Registry Network (PECARN).