Time to First Analgesic Administration in the Emergency Department for Adolescents/Young Adults With Sickle Cell Disease: A Retrospective Cross-Sectional Study

Abstract

Many adolescent and young adult (AYA) patients with sickle cell disease (SCD) visit the emergency department (ED) for vaso-occlusive crisis (VOC) pain management. Clinical guidelines from the National Heart, Lung, and Blood Institute (NHLBI) suggest that patients should receive an Emergency Severity Index (ESI) of 2 and analgesics within 60 minutes of registration. Despite guidelines, SCD patients experience treatment delays. Our objectives are to describe a Mid-Atlantic healthcare system's guideline adherence and examine the effect of time to first analgesic administration (TFAA) on ED disposition. A retrospective cross-sectional study of the electronic health record data set of ED SCD patient encounters from July 2016 to June 2017 was conducted. Descriptive statistics were run for patient characteristics. ED encounters that followed NHLBI guidelines were included in the data set. Independent t-tests were conducted to examine TFAA differences among patients admitted and not admitted. Majority of encounters were classified as ESI 3 (75.6%), and the mean TFAA was 108.9 minutes. Of ED encounters, 23.9% followed ESI guidelines, 21.5% followed TFAA guidelines, and 4.1% followed both NHLBI guidelines. There was a nearly significant difference in mean TFAA among patients discharged from the ED and admitted to the hospital, a mean difference of-24.5 minutes (t=-1.925; p=0.056). Despite existing ED guidelines, SCD patients experience delayed and variable care. Our results show faster TFAA could potentially decrease admission rates.