Increasing ketamine administration in children's hospitals for youth with sickle cell disease

Ketamine is recommended as an opioid-sparing adjunct for sickle cell disease (SCD)-related pain management. Little is known regarding its use in hospitalized youth with SCD. We aimed to describe trends in ketamine administration and examine associations between ketamine administration and outcomes in hospitalized youth with SCD. We conducted a cross-sectional, multicenter study examining hospital admissions for youth with SCD from 44 children's hospitals in the United States from 2016 to 2023. Youth aged ≥6 months with SCD were identified using International Classification of Diseases tenth revision codes. Exposures included age, sex, race, payor, childhood opportunity index, hydroxyurea administration, and concomitant methadone, buprenorphine, or gabapentinoid administration. The primary outcome was ketamine administration during admission. Secondary outcomes included length of stay, days on IV opioids, all-cause 14-day readmission rates, and intensive care unit stays during admissions with ketamine administered during the first 3 days of hospitalization (early) and hospital day 4 or later (late). From 2016 to 2023, 4.5% (n = 3391) of admissions for patients with SCD included ketamine administration, with prevalence increasing from 2.3% in 2016 to 5.7% in 2023 (P< .001). Age groups ≥12 years and the year ≥2019 was associated with increased odds of ketamine administration. Admissions with ketamine administration were also more likely to have administration of methadone and hydroxyurea. Early vs late ketamine administration was associated with shorter length of stay and fewer parental opioid days, indicating randomized controlled studies are needed to determine not only which patients benefit from ketamine but also the impact of early administration.