Do Children with Sickle Cell Disease Receive Disparate Care for Pain in the Emergency Department?

• Published in: The Journal of emergency medicine 2010-11, Vol.39 (5), p.691-695
• Main Authors: Zempsky, William T., MD, Loiselle, Kristin A., BS, McKay, Kathleen, PHD, Lee, Brian H., BS, Hagstrom, J. Nathan, MD, Schechter, Neil L., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Analgesics, Opioid - therapeutic use; Anemia, Sickle Cell - complications; Child; Child, Preschool; Connecticut; disparities; Emergency; Emergency Service, Hospital - organization & administration; Female; Healthcare Disparities - statistics & numerical data; Hospitals, Urban; Humans; Male; pain; Pain - drug therapy; Pain Management; Pain Measurement; Sickle cell disease; Triage; vaso-occlusive episode; Waiting Lists; Young Adult
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2009.06.003

Abstract Background: There may be disparities in pain management practice in the emergency department (ED) for sickle cell disease patients (SCD) with vaso-occlusive episodes (VOE). Objectives: To compare pain management practice for children who presented to the ED with VOE to those with isolated long bone fractures (LBF). Methods: Children who presented with a VOE or a LBF to a children's hospital ED during 2005 were included. A retrospective medical chart review was conducted for each patient visit. Data collected included demographics, pain scores, time from triage to analgesia, and analgesic intervention. Results: Seventy-seven patients with SCD had 152 visits to the ED for pain, and 219 patients had 221 visits for LBF. Fifty-five patients (108 visits) with SCD and 123 patients (124 visits) with LBF received opiates. Subsequent analysis was done on these groups. Patients with SCD were older, less likely to be male and more likely to be African-American than the LBF group. Patients with SCD had higher triage pain scores (7.7 ± 2.5 vs. 6.7 ± 3.0, p = 0.005) and spent less time in the waiting room (7.4 ± 9.0 vs. 12.1 ± 26.8 min, p = 0.10), were given higher initial opiate doses (0.09 ± 0.03 vs. 0.07 ± 0.03 mg/kg morphine, p < 0.001); however, time from triage to analgesic intervention did not differ (69.0 ± 42.6 vs. 70.4 ± 57.1 min, p = 0.92). Conclusions: No disparities in care for children with sickle cell pain were identified. More timely administration of opiates needs to be encouraged, assuming other factors such as time of day, ED census, and acuity permit.