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

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.

Keywords: emergency department; pain score; sickle cell.

FIGURE 1 |

Study flow diagram. 1: Primary billing diagnosis for SCD (ICD-10 = D57,* except sickle cell trait) or a chief complaint of sickle cell pain event or sickle cell fever and received at least one parenteral opioid pain medication in the ED. Visits from January 2017 through November 2021. 2: Visits could be ineligible due to more than one exclusion criteria. 3: Left against medical advice, left without being seen, or missing disposition.

FIGURE 2 |

Association between ED opioid doses administered/receipt of an opioid prescription at discharge and 14-day ED return visit rates.