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Emergency Department Utilization by Pediatric Patients With Sickle Cell Disease in Basrah, Iraq
Ahmed S Marroof1, Meaad K Hassan2
1Department of Pediatrics, Al-Zubair general Hospital, Basrah Health Directorate, Basrah, IRQ.
Insights
Pediatric sickle cell disease patients frequently visit the Emergency Department (ED) for pain crises. One-third of these patients are readmitted within 30 days, highlighting the need for improved ED pain management and care guidelines.
Area of Science:
- Pediatric Hematology
- Emergency Medicine
- Public Health
Background:
- Sickle cell disease (SCD) commonly leads to emergency department (ED) visits for acute pain and complications.
- Understanding the patterns of ED utilization in pediatric SCD is crucial for resource allocation and care improvement.
Purpose of the Study:
- To analyze the reasons for ED visits in pediatric SCD patients.
- To assess the proportion of ED admissions attributed to SCD compared to other pediatric conditions.
- To evaluate treatment, outcomes, and readmission rates for pediatric SCD patients in the ED.
Main Methods:
- A prospective analytical study was conducted over six months at Basrah Maternity and Children Hospital.
- Data collected included sociodemographics, clinical information, drug history, ED length of stay, complications, outcomes, and readmissions for 276 pediatric SCD patients (ages 1-14).
Main Results:
- Pain was the primary reason for ED admission (73.91%), followed by infection (10.14%) and hemolytic crisis (6.15%).
- Non-steroidal anti-inflammatory drugs (NSAIDs) were the most common analgesia (80.4%), with limited opioid use (18.5%).
- Readmission within 30 days occurred in 29.71% of patients, associated with prior ED visits, longer ED stay, and severe disease.
Conclusions:
- Acute pain episodes are the leading cause of ED visits for pediatric SCD patients.
- Current pain management in the ED, particularly opioid use, may be insufficient, contributing to high readmission rates.
- Findings support developing local ED guidelines for pediatric SCD, focusing on pain management and reducing readmissions.
Abstract:
Background Patients with sickle cell disease (SCD) often present in the Emergency Department (ED) with acute and debilitating pain and other SCD-related complications. Objectives The objective is to analyze the causes of ED visits of pediatric patients with SCD, assess the burden of ED admission due to SCD in relation to other pediatric diseases, the treatment given, and the outcomes. Methods A prospective analytical study was conducted on children and adolescents with SCD, 1-14 years old who had been admitted to the ED at Basrah Maternity and Children Hospital over a six-month period. Patient's sociodemographic and clinical data, drug history, length of ED stay, complications, outcome, and readmissions were recorded. Results A total of 422 patients with SCD were admitted to ED during the study period representing 4.10% of the total admitted cases; 276(65.40%) of them were recruited in this study, and their mean age was 7.84 ±3.47 years. The main cause for ED admission was pain (73.91%), followed by infection (10.14%) and hemolytic crisis (6.15%). The mean duration of stay at ED was 6.11±1.87 hours. All admitted SCD patients had received analgesia; non-steroidal anti-inflammatory drugs (NSAIDs) were the commonest (80.4%), followed by acetaminophen (39.5%), and opioid narcotic (18.5%). Readmission within 30-days was reported in 82(29.71%) patients and was associated with the number of ED visits/last year (B=0.151, P=0.023), length of stay at ED (B=0.140, P=0.034) and severe disease (B=0.253, P<0.001). Conclusions Acute painful episodes were the main cause of ED admission. Although most patients with pain did receive NSAIDs, only a small percentage of them did receive opioids. About one-third of patients have been readmitted within 30 days, and readmission was associated with the number of ED visits/last year, disease severity, and length of ED stay. These findings can help in establishing local guidelines for managing such patients in the ED especially pain management.
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