TOPLINE:

Emergency Severity Index (ESI) 2 assignment in sickle cell disease (SCD) vaso-occlusive crisis reduces median time to first analgesia to 65 minutes compared with 178 minutes for ESI 3 (P < .001). Cox regression analysis reveals ESI as the sole significant factor correlating with time to first analgesia (hazard ratio [HR], 5.731; P < .001).

METHODOLOGY:

• Researchers conducted a retrospective study at a quaternary care hospital with 60,000 annual emergency department visits, examining patients at least 22 years with SCD vaso-occlusive crisis between April 1 and September 30, 2023.
• Analysis included 66 visits identified through International Classification of Diseases-10 code D57.3, excluding cases complicated by other diagnoses warranting ESI 2 assignment or other acute SCD diagnoses.
• Primary outcome measures focused on time from triage to first analgesia administration, while secondary outcomes examined time between first and second analgesic administration.
• Investigators collected demographic data, pain scores at triage, ESI assignment, and disposition information for analysis.

TAKEAWAY:

• Analysis of 66 emergency department visits by 41 unique patients revealed that 58% were women with a median age of 31 years, and that the hemoglobin SS genotype was most common at 63.4%.
• Median time to first analgesia was significantly shorter for ESI 2 patients at 65 minutes vs 178 minutes for ESI 3 (P < .001).
• Cox regression analysis revealed ESI as the only significant factor correlating with time to first analgesia administration (HR, 5.731; P < .001).
• Time to second analgesia showed no significant difference between groups, with medians of 72 minutes for ESI 2 vs 78 minutes for ESI 3 (P = .485).

IN PRACTICE:

“System-based interventions to ensure assignment of ESI 2 can improve adherence to evidence-based guidelines regarding prompt analgesia for patients with SCD presenting to an ED for VOC,” wrote the authors of the study.

SOURCE:

The study was led by Abdulaziz Abu Haimed, Department of Internal Medicine, University of Maryland Medical Center in Baltimore. It was published online in Blood Advances.

LIMITATIONS:

The study’s single-center, retrospective design limits generalizability, particularly given the setting in an overcrowded urban emergency department that may not represent other facilities across the country. The relatively small sample size may have restricted the ability to detect significant associations, while the short timeframe could have missed seasonal variations in emergency department volume that might affect results. Additionally, the study examined a process measure rather than discrete clinical outcomes, though improvements in time to first analgesia could increase patient satisfaction. The researchers measured time from triage rather than arrival, which may underestimate overall delays in analgesia administration.

DISCLOSURES:

Haimed, Drupad Patel, Octavia Clopton, Benoit Stryckman, Maria Baer, and Jennie Law reported having no disclosures. Richard Gentry Wilkerson disclosed having ties with Becton, Dickinson and Company; Roche Diagnostics; Global Blood Therapeutics; Novartis Pharmaceuticals; Egetis Therapeutics AB; Endpoint Health; CSL Behring; Pfizer; Cepheid; Eldon Biologicals A/S; the National Foundation of Emergency Medicine; and CoapTech through a National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.