Evaluation of Guideline-Recommended Pain Management in Acute Sickle Cell Crisis and Its Effect on Patient Outcomes

This was a retrospective, multi-site observational cohort of 233 encounters of patients with Sickle Cell Disease (SCD) who received analgesia for acute pain crisis related to SCD from January 1, 2019 to December 31, 2019. Patient encounters were categorized based on whether they received analgesia within guideline directed 60 minutes of emergency department (ED) arrival. The primary outcome was time to a pain score reduction of ≥30% on the numerical rating scale. Assessments were also conducted for potential disparities leading to suboptimal care. Time to pain score reduction of ≥30% was significantly less in those receiving analgesia within 60 minutes of arrival compared to delayed analgesia [3.5 hours (2.5-10) vs 8.0 hours (4.5-22.5), p < 0.001]. Patients receiving timely analgesia also saw a faster time to ED disposition and achieved pain reduction goals more frequently at hospital discharge. We found that patients with a history of substance use disorder documented in their chart were less likely to receive timely analgesia. Our study indicated that when patients with SCD received analgesia in accordance with guideline recommendations, pain goals were achieved faster with an improvement in outcomes. Providing optimal care can be difficult, but education and standardized policies may help mitigate this gap.