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.
Keywords
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Article info
Publication history
Published online: August 25, 2009
Accepted:
June 13,
2009
Received in revised form:
June 1,
2009
Received:
January 15,
2009
Footnotes
Supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
