Table 1.
Factors associated with emergency department discharge among children with sickle cell disease presenting with vaso-occlusive pain episodes.*
| Discharged (N=129), n (%) |
Admitted (N=268), n (%) |
Odds Ratio (95% CI) |
P value | Adjusted Odds Ratio (95% CI) |
P value | |
|---|---|---|---|---|---|---|
| Age | ||||||
| ≤12 years | 53 (41.1%) | 83 (31.0%) | Referent | 0.048 | Referent | 0.327 |
| >12 years | 76 (58.9%) | 185 (69.0%) | 0.64 (0.42, 1.00) | 1.44 (0.70, 3.07) | ||
| Sex | ||||||
| Male | 62 (48.1%) | 120 (44.8%) | Referent | 0.539 | ||
| Female | 67 (51.9%) | 148 (55.2%) | 0.88 (0.57, 1.34) | |||
| Presenting pain score, mean (SD) 1 | 7.7 (2.11) | 8.1 (2.16) | 0.91 (0.83, 1.00) | 0.062 | 0.71 (0.60, 0.83) | <0.001 |
| Change in pain score, mean (SD) 1 | −4.0 (3.04) | −1.7 (2.95) | 0.79 (0.73, 0.85) | <0.001 | 0.64 (0.55, 0.72) | <0.001 |
| Final pain score, mean (SD) 1 ** | 3.7 (3.04) | 6.4 (3.01) | 0.76 (0.71, 0.82) | <0.001 | ||
| Intranasal fentanyl administered | 38 (29.5%) | 36 (13.4%) | 2.69 (1.61, 4.52) | <0.001 | 8.99 (2.81, 30.56) | <0.001 |
| Time from ED arrival to first parenteral opioid 2 | ||||||
| ≤60 minutes | 68 (52.7%) | 120 (44.8%) | Referent | 0.046 | Referent | 0.377 |
| >60 minutes | 53 (41.1%) | 145 (54.1%) | 0.65 (0.42, 0.99) | 0.71 (0.33, 1.51) | ||
| Time from ED arrival to first IV opioid 3 | ||||||
| ≤60 minutes | 37 (28.7%) | 96 (35.8%) | Referent | 0.878 | ||
| >60 minutes | 62 (48.1%) | 167 (62.3%) | 0.96 (0.60, 1.56) | |||
| Time from first to second IV opioid 4 | ||||||
| ≤60 minutes | 18 (14.0%) | 89 (33.2%) | Referent | 0.258 | ||
| >60 minutes | 34 (26.4%) | 117 (43.7%) | 1.44 (0.77, 2.75) | |||
| Total parenteral opioid morphine equivalents (mg/kg), mean (SD) 5 | 0.18 (0.13) | 0.28 (0.27) | 0.97 (0.95, 0.98) | <0.001 | 0.93 (0.90, 0.96) | <0.001 |
| Total parenteral opioid morphine equivalents (mg/kg/hr), mean (SD) | 0.05 (0.04) | 0.06 (0.07) | 0.97 (0.92, 1.01) | 0.114 | ||
| Ketorolac administered | 81 (62.8%) | 182 (67.9%) | 0.80 (0.51, 1.24) | 0.314 | ||
| Oral opioids administered | 46 (35.7%) | 52 (19.4%) | 2.30 (1.44, 3.69) | <0.001 | 3.03 (1.43, 6.60) | 0.004 |
| Fever present (defined as ≥ 38C) | 13 (10.0%) | 28 (10.4%) | 0.96 (0.47, 1.89) | 0.909 | ||
| Bolus IV fluids administered | 73 (56.6%) | 187 (69.8%) | 0.56 (0.37, 0.87) | 0.010 | 0.75 (0.33, 1.65) | 0.470 |
| Time of day for ED presentation | ||||||
| Day shift | 56 (43.4%) | 107 (39.9%) | 0.91 (0.51, 1.63) | |||
| Evening shift | 47 (36.4%) | 116 (43.3%) | 0.70 (0.39, 1.27) | |||
| Overnight shift | 26 (20.2%) | 45 (16.8%) | Referent | 0.404 |
Excluding 5 patients who did not have documented initial pain score.
Excluding 11 patients who did not receive parenteral opioids.
Excluding 35 patients who did not receive IV opioids.
Limited to patients who received a second IV opioid.
Limited to patients with documented parenteral opioid dosages.
All analyses were adjusted for site. Three children were excluded from the regression analyses because they were not discharged or admitted (i.e., 2 were transferred elsewhere and 1 left against medical advice).
Final pain score was left out of the multivariable model since it is a linear combination of first pain score and change in pain score.