Timing of opioids and hospitalizations for sickle cell disease pain

Timing of opioids and hospitalizations for sickle cell disease pain | Image credit: sudok1 - stock.adobe.com.

Children with sickle cell disease (SCD) experiencing acute pain episodes were less likely to be hospitalized when opioids were administered promptly in the emergency department (ED), according to a new multisite cross-sectional study published in JAMA Pediatrics.¹

The analysis drew from more than 9,000 pediatric ED visits between January 2019 and December 2021 across 12 children’s hospitals in the United States with comprehensive SCD centers. Investigators used data from the Pediatric Emergency Care Applied Research Network Registry to evaluate whether timeliness of opioid dosing was associated with lower hospitalization rates. Eligible encounters included children aged younger than 19 years presenting with uncomplicated SCD pain, while visits involving other complications were excluded.

Researchers examined 2 key exposures: time from ED arrival to the first opioid dose, and the interval between the first and second doses. For each, several thresholds were assessed, ranging from 30 to 60 minutes. The primary outcome was whether patients were hospitalized following the ED visit.

Overall, more than half of the visits in the study period resulted in hospitalization. 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.

Even when the second dose occurred beyond the 30-minute threshold, timely administration of the first dose continued to show an association with decreased hospitalizations. The authors noted that although shorter intervals between the first and second doses achieved the most favorable outcomes, longer intervals were still linked with benefit compared with delayed initial treatment.

“The highest quality of care is to get that pain treatment quickly," said David Brousseau, MD, MS, in a video interview with Contemporary Pediatrics². Brousseau is pediatrician-in-chief and director of Research at Nemours Children’s Health and a study author.

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

"The rationale behind our study was that the emergency department is a place with a lot of patients with competing priorities," Brousseau added. "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.”

These findings align with existing clinical guidelines recommending that opioids be administered promptly to children with acute SCD pain but provide new, large-scale evidence of the association between dosing timeliness and reduced hospitalization risk. The results underscore the importance of not only initiating treatment quickly after arrival but also maintaining appropriate intervals between subsequent doses to achieve optimal outcomes.¹

The study also highlights the challenges pediatric EDs face in delivering timely care, given the complexity of managing SCD pain and potential systemic delays in crowded emergency settings. Still, the authors emphasized that adherence to timely dosing protocols could have a meaningful impact on reducing hospital admissions for children with SCD, with implications for both patient well-being and healthcare resource utilization.

“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.”

References:

1. 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
2. Fitch J. David Brousseau, MD, highlights impact of timely opioid dosing in pediatric sickle cell pain. Published September 5, 2025. Accessed September 8, 2025. https://www.contemporarypediatrics.com/view/david-brousseau-md-highlights-impact-of-timely-opioid-dosing-in-pediatric-sickle-cell-pain