325 - Protracted Timing to Opioid Administration for Sickle Cell Patients Presenting to a Community-Based Emergency Department Prolongs Length of Inpatient Stay Differentially Across Age

Publication Number: 325.6185

Miguel Pareja-Cajiao, BronxCare Health system, Bronx, NY, United States; Cristian J. Davalos Cristellot, Bronxcare Health System, New York, NY, United States; Jilu Jose, BronxCare Health Systems, Bronx, NY, United States; Saranya Radhakrishnan, Bronxcare Health System Hospital, Jamaica, NY, United States; Maria Carmela T. Rigunay, Bronx Care Health System, Bronx, NY, United States; Yara E. Perez, BronxCare Health Systems, Bronx, NY, United States

Background: Sickle Cell Disease (SCD) is a common genetic blood disorder that significantly impacts healthcare systems, particularly in the Bronx. Vaso-occlusive crisis (VOC) is the hallmark acute complication, and opioid analgesia is the standard treatment. The timing to opioid administration (TTO) has emerged as a potential quality indicator.

Objective: This study aims to determine the effects of opioid use and TTO on quality outcomes for SCD patients.

Design/Methods: We conducted a retrospective cohort review of patients presenting to the BronxCare pediatric emergency room with VOC from 2014 to 2023. The primary outcome was hospital admission. The secondary outcomes included TTO, visit duration, and number of opioid doses. Mixed regression models were used to evaluate the correlations between these outcomes (logistic for admission rate and demographic data; linear for visit duration and number of doses).

Results: From 2014 to 2023, there were 6,005 emergency visits for SCD, with 1,037 identified as VOC cases. A bimodal age distribution was observed, with increased visits among children aged 3-6 years and individuals over 17. Opioids were administered in 25% of cases, with a 22% admission rate. Patients receiving opioids were more likely to be admitted (RR 7.3; CI 5.7-9.4). TTO averaged 109 minutes for admitted patients and 87 minutes for those not admitted, but there was not an effect of TTO on admission rates or length of stay. However, analyses showed TTO influenced admission duration by age quartile (Q1: F1-31=8.1; p< 0.01; Q2: F1-112=8.8; p< 0.01), where roughly, a 100-minute extension in TTO increased admission duration by one day in patients 14 years-old or younger. Covariate analyses revealed male patients were more likely to be admitted (OR 2.1; CI 1.6-2.8) and to receive opioids (OR 2.8; CI 2.1-3.7) compared to females. Additionally, the median age of visits decreased during the pandemic, with a notable decline in 2020, becoming significant in 2023.

Conclusion(s): SCD continues to pose a significant healthcare challenge, especially in vulnerable communities like the South Bronx. Our findings align with previous studies, underscoring TTO as a crucial factor in improving patient care. While TTO did not affect admission rates, it impacted admission duration across age groups. Further research is necessary to explore TTO's effects in specific age cohorts. This study supports TTO as a quality indicator in VOC management.

Figure 1
Protracted TTO was associated with prolonged length of stray patients in age quartiles 1 and 2, but not in age quartiles 3 and 4

Figure 2
Age distribution changed during the pandemic years, where there was la larger proportion of younger patients than the preceding years

Figure 3
There was a bimodal distribution for the age of patients included in our study