A Multiyear Cross-sectional Study of Guideline Adherence for the Timeliness of Opioid Administration in Children With Sickle Cell Pain Crisis - 12/09/20
, Elizabeth R. Alpern, MD, MSCE b, James M. Chamberlain, MD c, Angela M. Ellison, MD, MSc d, Lalit Bajaj, MD, MPH e, Daniel M. Cohen, MD f, Selena Hariharan, MD, MHSA g, Lawrence J. Cook, PhD h, Monica Harding, MS h, Julie Panepinto, MD, MSPH athe
Pediatric Emergency Care Applied Research Network (PECARN)
Abstract |
Study objective |
The National Heart, Lung, and Blood Institute evidence-based guidelines for timeliness of opioid administration for sickle cell disease (SCD) pain crises recommend an initial opioid within 1 hour of arrival, with subsequent dosing every 30 minutes until pain is controlled. No multisite studies have evaluated guideline adherence, to our knowledge. Our objective was to determine guideline adherence across a multicenter network.
Methods |
We conducted a multiyear cross-sectional analysis of children with SCD who presented between January 1, 2016, and December 31, 2018, to 7 emergency departments (EDs) within the Pediatric Emergency Care Applied Research Network. Visits for uncomplicated pain crisis were included, defined with an International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 code for SCD crisis and receipt of an opioid, excluding visits with other SCD complications or temperature exceeding 38.5°C (101.3°F). Times were extracted from the electronic record. Guideline adherence was assessed across sites and calendar years.
Results |
A total of 4,578 visits were included. The median time to first opioid receipt was 62 minutes (interquartile range 42 to 93 minutes); between the first and second opioid receipt, 60 minutes (interquartile range 39 to 93 minutes). Overall, 48% of visits (95% confidence interval 47% to 50%) were guideline adherent for first opioid. Of 3,538 visits with a second opioid, 15% (95% confidence interval 14% to 16%) were guideline adherent. Site variation in adherence existed for time to first opioid (range 22% to 70%) and time between first and second opioid (range 2% to 36%; both P<.001). There was no change in timeliness to first dose or time between doses across years (P>.05 for both).
Conclusion |
Guideline adherence for timeliness of SCD treatment is poor, with half of visits adherent for time to first opioid and one seventh adherent for second dose. Dissemination and implementation research/quality improvement efforts are critical to improve care across EDs.
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| Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award 1U01HL143477-01. This project is also supported in part by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS), the Emergency Medical Services for Children program through the following grants: HOMERUN–Cincinnati Children’s Hospital Medical Center (U03MC22684), DCC–University of Utah (U03MC00008), GLEMSCRN–Nationwide Children’s Hospital (U03MC28844), PEMNEWS–Columbia University Medical Center (U03MC00007), PRIME–University of California at Davis Medical Center (U03MC00001), and WBCARN–Children’s National Medical Center (U03MC00006). Publication of this supplement was supported by the Office of Minority Health of the US Department of Health and Human Services. |
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| This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the US government. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication. |
Vol 76 - N° 3S
P. S6-S11 - septembre 2020 Retour au numéro
Article précédent
- Inconsistent Emergency Department Care: The Hidden Cost for Patients With Sickle Cell Disease
- Adrian F. Williams
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- Matthew Lyon, Lashon Sturgis, Richard Lottenberg, Marin E. Gibson, Jonathan Eck, Abdullah Kutlar, Robert W. Gibson
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