In adolescents with sickle cell disease (SCD) who present to the emergency department (ED), sex and history of high healthcare utilization for pain are linked to acute pain trajectories, according to findings from a retrospective review of electronic health records obtained from a large, urban, multicampus academic pediatric SCD program.

The results of the analysis were published in the journal Pain Reports.

Acute episodes of pain are known to be a major cause of pediatric and adult ED visits, as well as associated hospitalizations. Pain, which is the most frequent complication reported among individuals with SCD, has been linked to poor health-related quality of life, significant morbidity, and premature mortality. Those in the adolescent age group report an increased frequency of complications from SCD, especially pain.

The researchers sought to establish whether differences in acute pain trajectories based on sex and frequency of pain episodes exist among adolescents with SCD who presented to the ED. They identified all adolescents between 15 and 18 years of age who previously experienced an outpatient or an inpatient encounter at least 1 time in the past 2 years and who had a subsequent visit to the ED for SCD-associated pain in 2019. The last visit for SCD-related pain in 2019 was chosen for each participant as the “index ED visit under study,” regardless of the severity of an individual’s pain or the treatment provided.

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One hundred thirteen adolescents were included in the study cohort. The mean participant age was 16.6±0.9 years. Overall, 41.6% of the patients were female.

Results of the study showed that mean body mass index was significantly higher among female vs male participants (P =.006) and among those with high healthcare utilization (P =.004). The median number of healthcare utilization episodes for pain over 12 months was 2 (range, 1-5). In fact, 43.4% (49 of 113) of participants experienced 3 or more episodes of healthcare utilization for pain, which was defined as having a history of high healthcare utilization for pain.

Adolescents with a history of high healthcare utilization for pain exhibited the following characteristics:

  • Higher mean pain intensity scores at presentation;
  • Greater likelihood of receiving intravenous or intranasal opioids; and
  • Higher likelihood of hospitalization.

In a model in which the 3-way interaction among sex, history of high healthcare utilization for pain, and follow-up time from initial pain intensity score, adjusted for opioid dose per kilogram of body weight and prescription for hydroxyurea, adolescent females with high healthcare utilization for pain exhibited the slowest decline in pain intensity while undergoing treatment for acute pain in the ED.

“Sex and history of high healthcare utilization for pain are associated with acute pain trajectories in adolescents with SCD presenting to the ED,” the investigators emphasized. “These novel findings should be confirmed in future prospective studies,” they concluded.

Reference

Astles R, Liu Z, Gillespie SE, et al. Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease. Pain Rep. Published online August 7,2023. doi:10.1097/PR9.0000000000001084