David Brousseau, MD, highlights impact of timely opioid dosing in pediatric sickle cell pain

A new multisite study published in JAMA Pediatrics underscores the importance of timely opioid administration in the emergency department (ED) for children with sickle cell disease (SCD) experiencing acute pain crises. The findings suggested that faster initiation of pain management not only reduces suffering but also decreased the likelihood of hospitalization.

“Most people know sickle cell disease is a genetic disease that affects the red blood cells,” said study author David Brousseau, MD, MS, pediatrician-in-chief and director of Research at Nemours Children’s Health. “It causes pro-inflammation, it causes coagulation, and most commonly, that's represented as pain crises or pain episodes.”

The study analyzed more than 9,200 ED visits across 12 children’s hospitals between 2019 and 2021. Researchers examined the timing of opioid administration—specifically, whether the first dose was delivered within 60 minutes of ED arrival and whether the second dose followed within 30, 45, or 60 minutes.

Results showed that giving the first dose of opioids within 60 minutes was associated with decreased odds of hospitalization (OR, 0.84; 95% CI, 0.75-0.95). The impact was even greater when the second dose was administered promptly. "Evaluating combined first- and second-dose timeliness of opioid administration for the 7853 visits (85.1%) with 2 or more opioid doses, first-opioid timeliness was associated with reduced odds of hospitalization, even when the second dose was outside 30 minutes (OR, 0.85; 95% CI, 0.74-0.98) or 45 minutes (OR, 0.84; 95% CI, 0.72-0.97)," wrote the investigators.

“The highest quality of care is to get that pain treatment quickly. The rationale behind our study was that the emergency department is a place with a lot of patients with competing priorities. What we were hoping to show is that these guidelines, based on expert opinion, actually made a difference in whether children were able to go home.”

He added that many children with SCD endure frequent pain at home and may not display overt signs of distress in the ED.

“When you know someone has a painful condition that might be affecting them frequently, you really need to take their word for the pain they are having, because their body and their mindset have adapted.”

Ultimately, the study provides strong evidence to reinforce guideline recommendations from the National Heart, Lung, and Blood Institute and the American Society of Hematology.

“Timeliness isn’t just a nice thing,” Brousseau concluded. “It actually changes the lives of these patients in the ED, and maybe in whether they get to go home.”

Reference:

Gwarzo I, Coleman KD, McKinley K, et al. Opioid Timeliness in the Emergency Department and Hospitalizations for Acute Sickle Cell Pain. JAMA Pediatr. Published online September 02, 2025. doi:10.1001/jamapediatrics.2025.2967