Ketamine Use in Hospitalized Children and Young Adults with Sickle Cell Disease

Background National societies including the American Society of Hematology recommend ketamine, an N-Methyl-D-Aspartate receptor antagonist, as an opioid sparing adjunct for the treatment of refractory pain in sickle cell disease (SCD). Little is known regarding how it is being used nationally to tre...

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Published in:Blood 2024-11, Vol.144, p.3682-3682
Main Authors: Archer, Natasha, Power-Hays, Alexandra, Hendry, Erin Auriel, Valentino, Marin, Hall, Matthew, Kyler, Kathryn, Antoon, James, Tang Girdwood, Sonya, Goldman, Jennifer L., Morel, Armand, Savage, Timothy, Orth, Lucas, Jenkins, Ashley M
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Language:English
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Summary:Background National societies including the American Society of Hematology recommend ketamine, an N-Methyl-D-Aspartate receptor antagonist, as an opioid sparing adjunct for the treatment of refractory pain in sickle cell disease (SCD). Little is known regarding how it is being used nationally to treat hospitalized individuals with SCD. Aims: To describe ketamine use over time and examine associations between ketamine use and healthcare utilization outcomes in patients with SCD admitted to children's hospitals. Methods: We performed a multi-center cross-sectional study of individuals ≥ 6 months with SCD admitted to a Pediatric Health Information System (PHIS) contributing children's hospital (n= 43) from 2016-2022. We used ICD-10 diagnosis codes to identify SCD hospitalizations, excluding those with OR charges, direct admits, or transfers. Our outcome of interest was ketamine use during hospitalizations. To determine if ketamine use was associated with outcomes (i.e., length of stay (LOS), any cause 14-day readmission, parenteral opioid use during hospitalization), we used generalized estimating equations adjusting for patient demographics, hospital, hydroxyurea use and number of SCD related hospitalizations in the year prior as a proxy for SCD severity. We also tested whether early (≤ 72 hours) versus late (>72hours) ketamine use during admission was associated with hospital outcomes. Results: 15,261 children and young adults with SCD had a total of 64,545 hospitalizations. Ketamine was used in 2,809 (4.3%). Ketamine use increased from 2.3% of hospitalizations in 2016 to 5.9% in 2022 (p
ISSN:0006-4971
DOI:10.1182/blood-2024-194763