Brief report| Volume 39, ISSUE 5, P691-695, November 2010

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


      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.


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        • Frei-Jones M.J.
        • Baxter A.L.
        • Rogers Z.R.
        • Buchanan G.R.
        Vaso-occlusive episodes in older children with sickle cell disease: emergency department management and pain assessment.
        J Pediatr. 2008; 152: 281-285
        • Beiter Jr, J.L.
        • Simon H.K.
        • Chambliss C.R.
        • Adamkiewicz T.
        • Sullivan K.
        Intravenous ketorolac in the emergency department management of sickle cell pain and predictors of its effectiveness.
        Arch Pediatr Adolesc Med. 2001; 155: 496-500
        • Frush K.
        • Ware R.E.
        • Kinney T.R.
        Emergency department visits by children with sickle hemoglobinopathies: factors associated with hospital admission.
        Pediatr Emerg Care. 1995; 11: 9-12
        • Kunkel N.
        • Rackoff W.R.
        • Katolik L.
        • Ohene-Frempong K.
        Utilization of a pediatric emergency department by patients with sickle cell disease.
        Pediatr Emerg Care. 1994; 10: 79-82
        • Friedland L.R.
        • Pancioli A.M.
        • Duncan K.M.
        Pediatric emergency department analgesic practice.
        Pediatr Emerg Care. 1997; 13: 103-106
        • Todd K.H.
        • Samaroo N.
        • Hoffman J.R.
        Ethnicity as a risk factor for inadequate emergency department analgesia.
        JAMA. 1993; 269: 1537-1539
        • Hostetler M.A.
        • Auinger P.
        • Szilagyi P.G.
        Parenteral analgesic and sedative use among ED patients in the United States: combined results from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 1992–1997.
        Am J Emerg Med. 2002; 20: 139-143
        • Tamayo-Sarver J.H.
        • Hinze S.W.
        • Cydulka R.K.
        • Baker D.W.
        Racial and ethnic disparities in emergency department analgesic prescription.
        Am J Public Health. 2003; 93: 2067-2073
        • Pletcher M.J.
        • Kertesz S.G.
        • Kohn M.A.
        • Gonzales R.
        Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.
        JAMA. 2008; 299: 70-78
        • Todd K.H.
        • Deaton C.
        • D'Adamo A.P.
        • et al.
        Ethnicity and analgesic practice.
        Ann Emerg Med. 2000; 35: 11-16
        • Yen K.
        • Kim M.
        • Stremski E.S.
        • Gorelick M.H.
        Effect of ethnicity and race on the use of pain medications in children with long bone fractures in the emergency department.
        Ann Emerg Med. 2003; 42: 41-47
        • Tanabe P.
        • Myers R.
        • Zosel A.
        • et al.
        Emergency department management of acute pain episodes in sickle cell disease.
        Acad Emerg Med. 2007; 14: 419-425
        • Silbergleit R.
        • Jancis M.O.
        • McNamara R.M.
        Management of sickle cell pain crisis in the emergency department at teaching hospitals.
        J Emerg Med. 1999; 17: 625-630
        • Shapiro B.S.
        • Benjamin L.J.
        • Payne R.
        • Heidrich G.
        Sickle cell-related pain: perceptions of medical practitioners.
        J Pain Symptom Manage. 1997; 14: 168-174
        • Labbé E.
        • Herbert D.
        • Haynes J.
        Physicians' attitude and practices in sickle cell disease pain management.
        J Palliat Care. 2005; 21: 246-251