Journal
AMERICAN JOURNAL OF HEMATOLOGY
Volume 91, Issue 12, Pages 1175-1180Publisher
WILEY-BLACKWELL
DOI: 10.1002/ajh.24534
Keywords
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Categories
Funding
- National Institutes of Health National Heart, Lung, and Blood Institute (NIH/NHLBI) [1R01HL103427-01A1, 1K23 HL114636-01A1]
- Health Resources and Services Administration (HRSA)
- Maternal and Child Health Bureau (MCHB)
- Emergency Medical Services for Children (EMSC) Network Development Demonstration Program for the Pediatric Emergency Care Applied Research Network (PECARN) [U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, U03MC22685]
- Eunice Kennedy Shriver National Institute of Child Health and Human Development [5R01HD062347-01]
- [3R01HD062347-03S]
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The impact of emergency department (ED) treatment on outcomes of sickle cell disease (SCD) acute pain hospitalizations is not well described. We investigated whether length of stay (LOS) and change in health-related quality of life (HRQL) are affected by initial opioid dose and time to administration. We conducted secondary analyses of data from the randomized-controlled Magnesium for children in Crisis (MAGiC) trial. The primary outcome was LOS. Secondary outcome was change in HRQL, assessed using PedsQL SCD Pain and Hurt and Pain Impact Domains measured in ED and at discharge. Independent variables were (1) time to first IV opioid, (2) total initial opioid dose (mg/kg/hr of morphine equivalents administered between ED and first study drug), and (3) Time to first oral opioid. Spearman correlations determined the associations with LOS. Using two-sample t-tests, we compared mean change in HRQL scores between IV opioid initiated within 60 and > 60 min, opioid doses in the highest and lowest tertiles, and oral opioid initiated within 24 and > 24 hr. Two hundred and four patients participated at 8 sites. Mean (SD) age was 13.6 (4.7) years. Earlier initiation of oral opioids was strongly correlated with shorter LOS (r=0.61, P < 0.01). Higher initial opioid dose was weakly correlated with longer LOS (r=0.34, P < 0.01). Higher initial opioid doses (6 vs 22.2; P=0.01) and oral opioids initiated within 24 hr (5.7 vs -1.7, P=0.04) were associated with larger mean change in HRQL at discharge. Prospective trials evaluating the impact of ED care on outcomes of pain hospitalizations could improve SCD pain treatment. (C) 2016 Wiley Periodicals, Inc.
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