Written by Amanda Mathews
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For pediatric patients presenting with acute sickle cell pain, receiving a first dose of pain medications within one hour of ED arrival and second dose within the next half hour was associated with reduced need for hospitalizations.
Time is of the essence
This study was a cross-sectional analysis of data obtained by the PECARN registry from 12 pediatric EDs associated with children’s hospitals with comprehensive sickle cell disease (SCD) centers. Included were children under the age of 19 who presented with uncomplicated sickle cell pain and received at least one parenteral opioid medication. Children with other sickle cell complications, such as acute chest syndrome or splenic sequestration, were excluded.
The analysis included 9,233 ED visits from 2,538 unique patients. All patients had at least one opioid administered, 85.1% received a second opioid dose, and 58.1% received a third dose. Multivariable analysis showed that receiving the first opioid dose within 60 minutes of ED arrival was associated with decreased odds of admission (OR 0.84, 95%CI 0.75-0.95). Additionally, receiving a timely second dose of opioids––specifically, within 30 minutes of the first dose––was also associated with decreased odds of admission (OR 0.62, 95%CI 0.52-0.75). Doses within 45 and 60 minutes of the first dose also showed decreased admission odds, although a less robust effect.
This study was limited to pediatric emergency departments with comprehensive sickle cell programs and may be difficult to generalize to other practice environments.
How will this change my practice?
The timely treatment of acute sickle cell pain continues to be an area of struggle for EM. Delays are likely due to longer wait times, room availability, provider comfort, and bias . Reducing hospitalizations is something everyone can get behind in a health system, so I’m hopeful this study helps empower clinicians to order early pain medications for patients presenting with acute sickle cell pain. On top of that, it’s just the right thing to do for a patient population who suffers from such significant pain.
Source
Opioid Timeliness in the Emergency Department and Hospitalizations for Acute Sickle Cell Pain. JAMA Pediatr. 2025 Sep 2:e252967. doi: 10.1001/jamapediatrics.2025.2967. Epub ahead of print. PMID: 40892426; PMCID: PMC12406144.
