A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic.
OBJECTIVE
To determine whether there is a difference in time to initial analgesic for patients with acute pain from sickle cell disease (SCD) versus renal colic (RC) and to identify factors contributing to variance in time to analgesic.


METHODS
A retrospective cohort study of the adult emergency department (ED) patients with acute pain from SCD and RC in an urban ED (final ED discharge ICD-9 diagnosis codes were included). A structured medical record review abstracted the demographics, arrival shift, triage level, initial pain score, triage time, and time of initial analgesic dose. Data were compared with Kaplan-Meier plots of time to initial analgesic for both RC and SCD with the log-rank test to test for differences by disease category. A multivariable Cox regression model estimated differences in time to initial analgesic by disease category while controlling for other possible confounders.


RESULTS
Median time to initial analgesic was 80 minutes for patients with SCD (interquartile range, 48 to 145) versus 50 minutes for patients with RC (interquartile range: 30 to 96). Patients with SCD reported a higher pain score on arrival when compared with RC patients and were more frequently assigned a higher triage priority level (P=0.05). Covariates that contributed the most delays to the model were afternoon arrival [hazard ratio (HR): 0.35, P<0.01], low acuity triage level (HR: 0.42, P<0.01), SCD diagnosis (HR: 0.61, P<0.01), and inability to obtain intravenous access (HR: 0.71, P=0.01).


CONCLUSIONS
ED patients with SCD experienced longer delays in the administration of the initial analgesic compared with RC patients, despite higher arrival pain scores and triage acuity levels.
Lazio
Matthew P
MP
Departments of Emergency Medicine parallelDepartment of Emergency Medicine, The Institute for Healthcare Studies daggerFeinberg School of Medicine, Northwestern University, Chicago, IL, USA. matt.lazio@gmail.com
Costello
Heather H
HH
Courtney
D Mark
DM
Martinovich
Zoran
Z
Myers
Randall
R
Zosel
Amy
A
Tanabe
Paula
P
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D000755:Anemia, Sickle Cell / Q000150:complications*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007087:Illinois; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D056844:Renal Colic / Q000150:complications*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D014218:Triage / Q000458:organization & administration*
D000700:Analgesics