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Impact of early analgesia on hospitalization outcomes for sickle cell pain crisis
Author(s) -
Payne Jason,
Aban Inmaculada,
Hilliard Lee M.,
Madison Jennifer,
BemrichStolz Christina,
Howard Thomas H.,
Brandow Amanda,
Waite Emily,
Lebensburger Jeffrey D.
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27420
Subject(s) - medicine , dosing , opioid , emergency department , vaso occlusive crisis , breakthrough pain , retrospective cohort study , emergency medicine , acute pain , prospective cohort study , anesthesia , disease , pediatrics , sickle cell anemia , receptor , psychiatry
Abstract Background Painful events are the leading cause of hospitalizations for patients with sickle cell disease. Individualized pain plans targeting patient‐specific maximum opioid dosing may shorten hospitalization length and are recommended by national guidelines. Prior to implementing individualized sickle cell pain plans, we tested the hypothesis that a shorter time to achieve a maximum opioid dose would improve hospitalization outcomes. Procedure Two‐year IRB‐approved, retrospective study of pediatric patients admitted for vaso‐occlusive crisis (VOC). We recorded the emergency department admission time, order entry time for the maximum opioid dose during the hospitalization, and time of discharge orders. We categorized patients as infrequent if they required <3 admissions for VOC over two years and patients as frequent if they required ≥3 admissions for VOC over two years. To account for multiple admissions, generalized linear modeling was performed. Results We identified 236 admissions for acute pain observed in 108 patients. Achieving an earlier maximum opioid dose was significantly associated with shorter length of hospitalization for frequent and infrequent pain patients (both P ≤ 0.0001). As total hospitalization length can be impacted by the time a maximum opioid order was placed, we also analyzed hospitalization length after the maximum opioid order was placed. Frequent pain patients who achieved earlier analgesia had a significantly shorter hospitalization from the time the maximum opioid order was placed ( P = 0.03) while no association was found for infrequent pain patients ( P = 0.84). Conclusions Early achievement of maximum analgesia improved hospitalization outcomes and warrant further investigation in prospective studies of individualized pain plans.