Abstract
Children with sickle cell disease (SCD) commonly experience vaso-occlusive pain episodes (VOE) due to sickling of erythrocytes, which often requires care in the emergency department. Our objective was to assess the use and impact of intranasal fentanyl for the treatment of children with SCD-VOE on discharge from the emergency department in a multicenter study. We conducted a cross-sectional study at 20 academic pediatric emergency departments in the United States and Canada. We used logistic regression to test bivariable and multivariable associations between the outcome of discharge from the emergency department and candidate variables theoretically associated with discharge. The study included 400 patients; 215 (54%) were female. The median age was 14.6 (interquartile range 9.8, 17.6) years. Nineteen percent (n = 75) received intranasal fentanyl in the emergency department. Children who received intranasal fentanyl had nearly nine-fold greater adjusted odds of discharge from the emergency department compared to those who did not (adjusted odds ratio 8.99, 95% CI 2.81–30.56, p <.001). The rapid onset of action and ease of delivery without intravenous access offered by intranasal fentanyl make it a feasible initial parenteral analgesic in the treatment of children with SCD presenting with VOE in the acute-care setting. Further study is needed to determine potential causality of the association between intranasal fentanyl and discharge from the emergency department observed in this multicenter study.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 620-627 |
| Number of pages | 8 |
| Journal | American Journal of Hematology |
| Volume | 98 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2023 |
Funding
This study was supported by the NIH/NHLBI under Award Number R34HL122557 (to CRM), and in part by NIH/NCCIH K24AT009893 (to CRM) and the Pediatric Emergency Care Applied Research Network (PECARN), supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), in the Maternal and Child Health Bureau (MCHB), under the Emergency Medical Services for Children (EMSC) program through the following cooperative agreements: DCC‐University of Utah, GLEMSCRN‐Nationwide Children's Hospital, HOMERUN‐Cincinnati Children's Hospital Medical Center, PEMNEWS‐Columbia University Medical Center, PRIME‐University of California at Davis Medical Center, CHaMP node‐State University of New York at Buffalo, WPEMR‐Seattle Children's Hospital, and SPARC‐Rhode Island Hospital/Hasbro Children's Hospital. NB received funding from the NIH/NHLBI under award number 1K23HL140142 and 1K23HL140142‐03S1, from the Doris Duke Charitable Foundation COVID19 Fund to Retain Clinical Scientists‐PeRSEVERE Program at Emory University School of Medicine, and the Georgia Clinical and Translational Science Alliance under award UL1‐TR002378. The funders had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, or the preparation, review, approval of the manuscript, or decision to submit the manuscript for publication.
ASJC Scopus subject areas
- Hematology