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Emergency department crowding and analgesic delay in pediatric sickle cell pain crises
Rohit Shenoi1, Long Ma, Dorothy Syblik
1Department of Pediatrics, Baylor College of Medicine, TX, USA. rshenoi@bcm.tmc.edu
Insights
Emergency department crowding significantly delays pain relief for children with sickle cell crises. Higher patient volumes in the emergency department (ED) mean longer waits for essential analgesic administration.
Area of Science:
- Pediatric Emergency Medicine
- Hematology
- Health Services Research
Background:
- Sickle cell disease (SCD) is a common genetic disorder requiring frequent emergency department (ED) visits for pain management.
- Pediatric patients with SCD often experience severe pain crises that necessitate timely analgesic administration.
- Emergency department crowding is a growing concern impacting patient care and treatment timeliness.
Purpose of the Study:
- To evaluate the impact of emergency department crowding on the administration of analgesics to pediatric patients experiencing sickle cell pain crises.
- To identify specific factors contributing to delays in pain management for this vulnerable population.
Main Methods:
- A cross-sectional study was conducted in a children's hospital emergency department.
- Data collected included patient demographics, clinical features, triage acuity, pain scores, and time to analgesic administration.
- Emergency department census was used as the measure of crowding, and logistic regression analyzed the association between crowding and analgesic delay, controlling for covariates.
Main Results:
- The study analyzed 232 encounters involving pediatric patients with sickle cell pain crises.
- The median time to analgesic administration was 90 minutes, with only 30% receiving analgesia within 60 minutes.
- Increased emergency department census was significantly associated with delayed analgesic administration, while younger age and severe pain at triage were associated with earlier administration.
Conclusions:
- Emergency department crowding is a significant factor contributing to delays in providing timely pain relief to pediatric patients with sickle cell pain crises.
- Addressing ED crowding is crucial for improving the quality of care and patient outcomes for children with SCD.
Objectives:
The objectives of the study were to test the impact of emergency department (ED) crowding and to identify factors associated with delay in analgesic administration in pediatric sickle cell pain crises.
Methods:
This was a cross-sectional study at a children's hospital ED. Data included demographics, clinical features, triage acuity, 10-level triage pain score, and arrival-to-analgesic-administration time. Emergency department census was the crowding measure assigned to each patient at arrival. Severe pain was a triage pain score of more than 7. Delays of more than 60 minutes from arrival to analgesic administration represented poor care. Logistic regression tested the effect of ED census on time to analgesic administration after adjusting for patient demographic and clinical characteristics.
Results:
From 243 encounters (161 patients), we excluded 11 visits (missing charts [n = 7], no pain at triage [n = 3], analgesic refusal [n = 1]). Final analysis involved 232 encounters (150 patients). Most were black with hemoglobin SS. Median age was 12 years. Mean ED census was 57. Median time from arrival to analgesic administration was 90 minutes. Analgesics were administered in less than 60 minutes in 70 encounters (30%). Most delays occurred after triage. Univariate analysis revealed that analgesic administration within 60 minutes of arrival was associated with severe pain at triage. After controlling for other factors, analgesic administration was significantly delayed during higher ED census and significantly earlier for young children and those with severe pain at triage. The time to analgesic administration from arrival significantly increased per increasing quartile of ED census (P = 0.0009).
Conclusion:
Emergency department crowding is associated with delay in analgesic administration in pediatric patients with sickle cell pain crisis.
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