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Comparative Study
. 2018 Jan;36(1):88-92.
doi: 10.1016/j.ajem.2017.07.037. Epub 2017 Jul 13.

Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit

Robert E Molokie  1 , Chariz Montminy  2 , Corissa Dionisio  3 , Muhammad Ahmen Farooqui  4 , Michel Gowhari  5 , Yingwei Yao  6 , Marie L Suarez  7 , Miriam O Ezenwa  8 , Judith M Schlaeger  9 , Zaijie J Wang  10 , Diana J Wilkie  11
Affiliations
Comparative Study

Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit

Robert E Molokie et al. Am J Emerg Med. 2018 Jan.

Abstract

Background: Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay.

Methods: In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay.

Findings: Pain on admission to the ED averaged 8.7±1.5 and to the ACU averaged 8.0±1.6. The average pain on discharge from the ED was 6.4±3.0 and for the ACU was 4.5±2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted.

Conclusions: Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions.

Keywords: Acute care unit; Emergency department; Hospital admission; Opioid; Pain; Sickle cell disease.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Initial and discharge pain ratings in two settings: emergency department (ED) and acute care unit (AC).
See this image and copyright information in PMC

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