Opioid Prescription Practices May Influence Pain Episodes in Pediatric Sickle Cell Disease

DECEMBER 02, 2015
Caitlyn Fitzpatrick
Thirty-day emergency room readmissions due to acute pain is not uncommon in children with sickle cell disease, and researchers suspect that opioid prescription practices has something to do with it.

Lower revisits rates can be achieved with scheduled opioid prescription rather than as needed or no opioids, hypothesized a team from the Division of Hematology, Oncology, & Stem Cell Transplant at the Ann & Robert J. Lurie Children’s Hospital of Chicago. However, the results came back with mixed results. Leslie Okorji, BS, will discuss the results in a poster session at the 57th American Society of Hematology Annual Meeting (ASH 2015) in Orlando, Florida.

A total of 97 patients who made up 290 admissions (110 emergency department discharge, 180 hospital discharge) were reviewed from June 2009 to May 2014. The children with sickle cell disease went to the hospital with an acute pain diagnosis episode and ranged from ages 7 to 21 (average being 11.9). The population was nearly half male and female and they all had no more than seven hospitalization within one year.

“Compared to hospital discharges, discharge from the emergency department for acute pain was associated with a higher incidence of 30-day returns,” the authors detailed. Fifty-six out of the 290 admissions (19%) resulted in a revisit or readmission to the emergency department (regardless if the initial discharge was from the hospital or emergency department). Out of the 290 patients, 259 of them (89%) received an opioid prescription at the time of discharge with the practice being more common in hospital discharge (96%) compared to emergency department (79%). Out of the 180 hospitalizations that latest for the median stay of four days, 159 of them (88%) were treated with parenteral opioids that were often patient-controlled analgesia. Patients who were not prescribed opioids were either given non-steroidal anti-inflammatory drugs (NSAIDs) or nothing at all.

However, the authors’ hypothesis was not supported and they wrote: “In general, we found no association between prescribed opioid frequency and incidence of 30-day returns. Prescription of scheduled opioids was similar between encounters that did or did not result in a 30-day emergency department revisit or readmission (46% versus 48%).”

The team took other factors into consideration during the evaluation, but only found that NSAIDs, not opioids, were independently associated with a higher incidence of 30-day emergency revisits, not readmissions. Age, sex, genotype, or hydroxyurea use did not influence revisit or readmission rates in the emergency department.

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