Okorji Leslie M, Muntz Devin S, Liem Robert I
Division of Hematology, Oncology & Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Pediatr Blood Cancer. 2017 May;64(5). doi: 10.1002/pbc.26319. Epub 2016 Nov 1.
Acute pain episodes in children with sickle cell disease (SCD) represent a leading cause of readmissions. We examined prescription practices at the time of discharge in children with SCD presenting with acute pain to determine their impact on 30-day emergency department (ED) revisits and readmissions.
In this single-institution, 5-year retrospective study, we reviewed 290 encounters of patients with SCD aged 7-21 years hospitalized or discharged from the ED with acute pain. We reviewed demographic, treatment and discharge data, and 30-day returns, defined as ED revisits and readmissions within 30 days of discharge. Bivariate and multivariable analyses were performed to evaluate the association between discharge prescription practices and 30-day returns.
Compared to hospitalizations, treat-and-release ED visits for acute pain were associated with a higher incidence of 30-day returns (OR = 2.7 [95% CI: 1.5-4.8], P < 0.01). We found no association between prescribed opioid frequency (scheduled vs. as-needed) and 30-day returns (OR = 1.12 [95% CI: 0.62-2.02], P = 0.70). By multivariable logistic regression, the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) only, without opioids, after treat-and-release ED visits was independently associated with a higher frequency of 30-day ED revisits (OR = 6.9 [95% CI: 1.3-37.3], P = 0.03) but not readmissions.
Variability exists in opioid prescription practices after discharge in children with SCD and pain episodes. Prescription of NSAIDs only, without opioids, was an independent predictor of higher 30-day ED revisits. Formalized studies to better understand factors that influence returns, including outpatient opioid management, are warranted in this population.
镰状细胞病（SCD）患儿的急性疼痛发作是再次入院的主要原因。我们研究了因急性疼痛就诊的SCD患儿出院时的处方情况，以确定其对30天内急诊复诊和再次入院的影响。
在这项单机构、为期5年的回顾性研究中，我们回顾了290例7至21岁因急性疼痛住院或从急诊出院的SCD患者的就诊情况。我们审查了人口统计学、治疗和出院数据，以及30天内的复诊情况，定义为出院后30天内的急诊复诊和再次入院。进行双变量和多变量分析以评估出院处方情况与30天复诊之间的关联。
与住院治疗相比，因急性疼痛接受治疗后出院的急诊就诊与30天复诊的发生率较高相关（OR = 2.7 [95% CI：1.5 - 4.8]，P < 0.01）。我们发现规定的阿片类药物使用频率（定期与按需）与30天复诊之间没有关联（OR = 1.12 [95% CI：0.62 - 2.02]，P = 0.70）。通过多变量逻辑回归分析，在因急性疼痛接受治疗后出院的急诊就诊后仅开具非甾体抗炎药（NSAIDs）而不使用阿片类药物，与30天内急诊复诊频率较高独立相关（OR = 6.9 [95% CI：1.3 - 37.3]，P = 0.03），但与再次入院无关。
SCD患儿疼痛发作出院后的阿片类药物处方情况存在差异。仅开具NSAIDs而不使用阿片类药物是30天内急诊复诊频率较高的独立预测因素。有必要进行正规研究以更好地了解影响复诊的因素，包括门诊阿片类药物管理，在这一人群中。
