David Brousseau is the pediatrician-in-chief, chair of pediatrics, and director of research at Nemours Children's Health. 

Prior ED Visits, Opioid Doses Predict Return Rates in Pediatric SCD Pain, With David Brousseau, MD, MS

New research suggests having ≥4 emergency department (ED) visits in 6 months or receiving ≥3 parenteral opioid doses are the strongest predictors of return visits for children with

American Society of Hematology (ASH) Annual Meeting and Exposition 

by David Brousseau, MD, MS, the pediatrician-in-chief, chair of pediatrics, and director of research at Nemours Children's Health.

“We know that in children who are discharged from the ED following a pain visit, about 30% of them, within 2 weeks, return to that same ED with another pain episode,” Brousseau told 

. “Our goal was to determine if we could predict which patients were going to return so that we could potentially intervene.”

SCD pain episodes can last from hours to days and be severe enough to require hospitalization. When it comes to pediatric SCD pain, > 1 in 4 children treated in the ED return within 14 days of discharge, but the patient-specific factors that impact this rate have not previously been determined.

Leveraging data from the Pediatric Emergency Care Applied Research Network (PECARN), investigators conducted a multicenter retrospective study of 5920 ED visits for acute SCD pain resulting in discharge. Their primary objective was to evaluate the association between return visits and patient-level factors such as site, age, sex, ED opioid doses, ED pain scores, receipt of an opioid prescription at discharge, Childhood Opportunity Index, primary payer, as well as prior ED utilization patterns (visits in the last 6 months, distance from the ED).

Among the study population, 47.5% of patients were younger than 12 years of age, 50% were male, and 95% were Black and non-Hispanic. Investigators identified a 28% ED return-visit rate within 14 days.

Upon univariable analyses, investigators identified several factors associated with return visits. These included age, distance from home to ED, number of opioid doses administered, initial pain score, number of prior ED visits, and return visits for uncomplicated SCD in the previous 6 months.

In the initial CART analysis, investigators determined the primary splitting variable as the number of ED visits in the prior 6 months for uncomplicated SCD pain. Children with ≥4 ED visits in the prior 6 months (n = 537) had a 51% return visit rate compared to a 25.7% return rate for those with <4 (n = 4315). In the validation set, there were 123 visits from children with ≥4 prior visits, and of them, 81.8% had a return visit within 14 days (n = 76). Using this set, the model performance yielded a sensitivity of 77.6% and a specificity of 32.8%.

In repeat CART analysis, investigators found children with ≥3 parenteral opioid doses, a pain score of 9/10, or who lived within 14.7 km of the ED (n = 3473) had a 31.5% return visit rate compared to 20.7% in those without (n = 1379). Receipt of ≥3 parenteral opioids was the primary splitting variable, associated with a 35.4% return rate compared with 25.6% among those who received 1–2 doses. Combining both risk indicators, ≥3 parenteral opioids or ≥4 ED visits in 6 months, resulted in a 36.8% return-visit rate within 14 days.

“The next step is to get the sickle cell patient, or sickle cell warrior, the people with lived experience, to tell us what it is that is making them come back,” Brousseau said. “We can just guess on our own, but the idea would be to actually hear from the patients and say why they came back that day, because that will really help us tailor the interventions.”

Editor’s Note: Brousseau reports no relevant disclosures.

Brousseau D, Coleman K, Brandow A, et al. Prediction model for pediatric return visits for sickle cell disease post-emergency department discharge for acute pain. Abstract presented at the 67th American Society of Hematology Annual Meeting. Orlando, FL. December 6-9, 2025.

World Health Organisation. Sickle-cell disease. Who.int. Published August 6, 2025. 

https://www.who.int/news-room/fact-sheets/detail/sickle-cell-disease

Articles

Recent research identifies key predictors for return visits to the emergency department (ED) among children with sickle cell disease (SCD) experiencing pain. Frequent ED visits (≥4 in 6 months) and receiving multiple parenteral opioid doses (≥3) are significant indicators. A study involving 5920 ED visits revealed a 28% return rate within 14 days, with factors like age, distance from ED, and initial pain score influencing this. The study emphasizes the need for patient input to better understand and address the reasons behind these return visits.

A prediction model ties emergency visits and opioid doses with return visits in children with sickle cell disease pain. 

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Rocco Serrao, MD, works for Dermatologists of Southwest Ohio, an affiliate practice of Dermatologists of Central States (DOCS), and as an associate clinical professor of Dermatology at Wright State University.

Discussing INTEGUMENT-INFANT and Roflumilast Cream 0.05% in Atopic Dermatitis, With Rocco Serrao, MD

The open-label, phase 2 INTEGUMENT-INFANT clinical study, assessing investigational once-daily roflumilast (Zoryve) cream 0.05%, recently completed enrollment.

The study is evaluating the safety and tolerability of investigational once-daily roflumilast (Zoryve) cream 0.05% in infants aged 3 months to less than 24 months living with 

. To discuss the significance of this analysis, 

 spoke with Rocco Serrao, MD, an associate clinical professor of Dermatology at Wright State University.

“There's such a paucity of these therapies available in the atopic space in general, but then especially in our young ones, especially our infants,” Serrao explained. “Here we're talking a population in this trial, three months of age up to two years. So, [we have] just a real lack of therapies for this population.”

Serrao noted 9.4 million children around the world suffer from the skin disease, with 60% being diagnosed before 1 year of age. Current treatments are limited, Serrao explained, with topical options such as steroids and calcineurin inhibitors often insufficient for long-term management of atopic dermatitis.

, is using endpoints such as Investigator's Global Assessment (IGA) success as well as percent change from the point of baseline in Worst Itch-Numeric Rating Scale (WI-NRS), Eczema Area and Severity Index (EASI), and Dermatology Life Quality Index (DLQI), Patient-Oriented Eczema Measure (POEM).

“Some parents and caregivers are hesitant to put their child on a systemic drug with maybe no end in sight,” Serrao said. “They want to try, hopefully, to avoid putting a systemic treatment in their child's body, no matter how safe it is or how safe it's perceived to be, just because they're concerned as a parent. They may want to try and avoid systemic therapy. There's a huge need for therapies that are topical to manage [atopic dermatitis].”

For additional information, view the full video interview with Serrao posted above.

The quotes contained in this interview were edited for the purposes of clarity.

Hebert A, Eichenfield L, Burnett P, et al. INTEGUMENT-INFANT: A Phase 2, 4-Week Open-Label Safety Study of Roflumilast Cream 0.05% in Infants Aged 3 Months to Less than 2 Years Old With Mild-to-Moderate Atopic Dermatitis. Poster presented at the DERM 2025 NP/PA CME Conference; July 23 - 26, 2025; Las Vegas, Nevada.

Hebert A. Safety of Roflumilast Cream 0.05% in Infants and Toddlers with Atopic Dermatitis, with Adelaide Hebert, MD. HCPLive. August 1, 2025. Accessed December 11, 2025. 

https://www.hcplive.com/view/safety-roflumilast-cream-0-05-infants-toddlers-atopic-dermatitis-adelaide-hebert-md

The INTEGUMENT-INFANT phase 2 study has completed enrollment to evaluate the safety and tolerability of roflumilast cream 0.05% in infants with mild to moderate atopic dermatitis. This demographic, aged 3 months to less than 24 months, has limited treatment options, with current therapies often inadequate for long-term management. The study uses endpoints like IGA success and changes in WI-NRS, EASI, DLQI, and POEM. Parents often prefer topical treatments over systemic ones due to safety concerns, highlighting the need for effective topical therapies.

In this interview, Serrao discusses the significance of the phase 2 INTEGUMENT-INFANT study, assessing once-daily roflumilast (Zoryve) cream 0.05% in infants with atopic dermatitis.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

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The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Linda Stein Gold, MD, is a dermatologist at Henry Ford Health. 

Review of new week 52 results showing durable responses and strong efficacy in both adults and adolescents.

Icotrokinra vs Deucravacitinib: Results from the ICONIC-ADVANCE 1 and 2 Trials 

, despite the expanding therapeutic landscape. Linda Stein Gold, MD, and her colleagues analyze patient- and provider-reported data from the 

 surveys, revealing that many patients remain dissatisfied with current therapies and that oral agents are overwhelmingly preferred over injectables. The experts discuss how patient lifestyle, comorbidities, and psychosocial burden influence shared decision-making and treatment adherence. They also interpret the 

International Psoriasis Council’s (IPC)

 and explore its implications for reducing “topical churn” and advancing systemic therapy earlier in the disease course.

 and its potential to close current gaps in care. The panel provides an in-depth review of the 

 clinical development program, summarizing the 

 trials, which demonstrated superior efficacy versus deucravacitinib at both 16 and 24 weeks, with favorable safety and tolerability. They also discuss new 

 showing sustained clearance and no new safety signals in adults and adolescents. The faculty reflect on ICO’s implications for adolescent psoriasis and how early, aggressive oral intervention may help prevent progression to psoriatic arthritis, marking a significant milestone in the evolution of oral IL-23–targeted therapy.

The final portion of the series shifts focus to 

managing active psoriatic arthritis (PsA)

. The experts discuss new findings from the 

 demonstrated the first clear evidence of IL-23–mediated inhibition of structural joint damage, reinforcing the rationale for early biologic use in high-risk patients. They compare APEX to prior IL-23 studies, discuss implications for therapy sequencing, and highlight other emerging data from 

 studies. In closing, Stein Gold and colleagues emphasize a forward-looking approach that integrates personalized therapy selection, early detection of PsA, and cross-specialty collaboration to elevate standards of psoriasis care

Videos

Video Series

Discussion of nasopharyngitis and URTI as the most common AEs and how the safety profile compares to other oral agents.

Treating High-Impact Areas in Psoriasis: Results From the ICONIC-TOTAL and SPECTREM Trials

Valeria Cohran, MD is a professor of pediatrics and the medical director of intestinal rehabilitation and transplant at Ann and Robert H Lurie Children's Hospital of Chicago.

Predicting Teduglutide Treatment Response for Pediatric SBS-IF, With Valeria Cohran, MD

New research is shedding light on the characteristics of children with short bowel syndrome-associated intestinal failure (SBS-IF) by response to teduglutide, including attainment of consistent response and sustained enteral autonomy.

2025 North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)

 Annual Meeting by Valeria Cohran, MD, a professor of pediatrics and the medical director of intestinal rehabilitation and transplant at Ann and Robert H Lurie Children's Hospital of Chicago.

Teduglutide, first approved by the US Food and Drug Administration for adults with SBS in 2012, was later granted approval for pediatric patients ≥ 1 year of age with SBS who need additional nutrition or fluids from intravenous feeding in 2019. The human glucagon-like peptide-2 analog reduces PN/IV dependency in children with SBS-IF, but identifying patient characteristics that predict response to teduglutide is crucial for guiding clinical decisions.

“The reason we wanted to do this study was to evaluate the characteristics of children with short bowel syndrome and intestinal failure, and by looking at the response to teduglutide, trying to see what certain characteristics may predict who's going to be a responder to this medication,” Cohran told 

This post hoc analysis pooled data from pediatric patients who took part in 1 of 2 open-label, multicenter, phase 3, long-term extension (LTE) studies over 96 weeks and their respective parent studies. Patients were grouped by whether or not they were consistent responders, defined as ≥20% PN/IV volume reduction from baseline for ≥90 consecutive days during parent and LTE studies, and whether or not they attained sustained enteral autonomy, defined as 100% reduction from baseline in PN/IV for ≥90 consecutive days.

In total, 23 patients were consistent responders and 46 were non-consistent responders. Of the non-consistent responders, 9 had no response, 1 had a response only during a parent study, 15 had a response only during an LTE study, and 21 had a response during both parent and LTE studies for <90 days. A total of 18 patients attained sustained enteral autonomy.

For patients with data available, consistent responders were significantly older (mean age, 7.9 vs 4.4 years; 

<.001), had longer mean time since SBS diagnosis (7.1 vs 5.0 years; 

= .016), and lower mean baseline PN/IV volume (53.5 vs 70.5 mL/kg/day; 

= .030) and duration (10.7 vs 13.1 hours/day; 

Investigators noted a significantly greater proportion of consistent responders had an ileocecal valve present (30.4% vs 15.2%; 

= .047) and a lower proportion had some remaining colon than non-consistent responders (87.0% vs 100.0%; 

= .012). Patients who attained sustained enteral autonomy were significantly older (mean age, 7.1 vs 5.0 years; 

= .036), had greater mean length of remaining small intestine (57.3 vs 36.3 cm; 

= .036), and lower mean baseline PN/IV volume (48.6 vs 70.6 mL/kg/day; 

= .008) and duration (10.3 vs 12.7 hours/day; 

Univariate analyses identified older age at baseline and longer time since SBS diagnosis to be significantly associated with greater likelihood of consistent response, and older age at baseline and length of remaining small intestine to be significantly associated with greater likelihood of sustained enteral autonomy (

<.05). Of note, due to small sample sizes, multivariate analyses were not conducted.

“We need longer term studies, and as more patients are being treated with this drug, that's going to allow us to have more information about who is going to be a better responder to this agent,” Cohran said.

Editors’ Note: Cohran reports relevant disclosures with Takeda.

Cohran V, Carter B, Kocoshis S, et al. CHARACTERISTICS ASSOCIATED WITH RESPONSE TO TEDUGLUTIDE TREATMENT IN CHILDREN WITH SHORT BOWEL SYNDROME-ASSOCIATED INTESTINAL FAILURE: A POST HOC ANALYSIS OF LONG-TERM EXTENSION STUDIES. Presented at 2025 NASPGHAN Annual Meeting. November 5-9, 2025. Chicago, Illinois.

Pessoa Gingerich C. FDA Approves Teduglutide for Pediatric Use. HCPLive. May 17, 2019. Accessed December 10, 2025. 

https://www.hcplive.com/view/fda-approves-teduglutide-for-pediatric-use

Recent research has explored the characteristics of pediatric patients with short bowel syndrome-associated intestinal failure (SBS-IF) in response to teduglutide treatment. The study identified factors predicting consistent response and sustained enteral autonomy, such as older age, longer time since diagnosis, and specific anatomical features. Consistent responders were generally older, had longer time since SBS diagnosis, and lower baseline PN/IV volume. The presence of an ileocecal valve and longer remaining small intestine were also significant. The study highlights the need for further research to better predict patient response to teduglutide.

Cohran describes her research on characteristics linked to treatment response to teduglutide for short bowel syndrome-associated intestinal failure.

Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

Experts discuss the future of retinal disease treatments, highlighting the promise of new therapies and the need for personalized patient care.

 Integrating Gene Therapy and TKIs with Current Second-Generation Anti-VEGF Agents in Clinical Practice

Experts discuss evolving strategies in treat-and-extend protocols for retinal diseases, emphasizing OCT's role in optimizing patient care and outcomes.

Treat-and-Extend Strategies with Second-Generation Anti-VEGF in Patients with Retinal Vascular Diseases

Experts discuss the safety of retinal treatments, addressing concerns about rare side effects and emphasizing the overall efficacy of these medications.

Reinforcing Safety and Patient Confidence with Second-Generation Anti-VEGF Therapies

Experts discuss switching from 2 mg to 8 mg treatments for AMD and DME, emphasizing loading strategies and reduced steroid use in practice.

Optimizing Treatment Transitions and Reducing Steroid Use with Second-Generation Anti-VEGF Therapies in Retinal Vascular Diseases

Healthcare professionals discuss the integration of second-generation medications into practice, emphasizing patient-specific responses and treatment challenges.

Integrating Second-Generation Anti-VEGF Therapies into Clinical Practice 

Experts discuss promising results from the Quasar trial for Eylea 8 mg, highlighting its potential impact on retinal vein occlusion treatment strategies.

Aflibercept 8 mg in Patients with RVO 

Explore the latest findings from the Pulsar and Photon trials, highlighting innovative treatment extensions for AMD and DME patients.

Long-Term Insights with the High-Dose Anti-VEGF Agent Aflibercept 8 mg In AMD and DME Management 

Physicians discuss the promising durability and safety of Flibrice 8 mg, highlighting its potential to improve patient care in challenging cases.

The Role of Faricimab in Extending Durability and Treating Retinal Vascular Diseases

Experts discuss advancements in retinal vascular disease treatment, focusing on the impact of next-generation anti-VEGF therapies and their safety.

Enhancing Treatment Durability with Second-Generation High-Dose Anti-VEGF Agents in Retinal Vascular Diseases 

Discover insights on evolving retinal care standards with next-generation anti-VEGF therapies from leading experts in the field.

Latest News

Prior ED Visits, Opioid Doses Predict Return Rates in Pediatric SCD Pain, With David Brousseau, MD, MS

Discussing INTEGUMENT-INFANT and Roflumilast Cream 0.05% in Atopic Dermatitis, With Rocco Serrao, MD

Icotrokinra vs Deucravacitinib: Results from the ICONIC-ADVANCE 1 and 2 Trials

Treating High-Impact Areas in Psoriasis: Results From the ICONIC-TOTAL and SPECTREM Trials

Predicting Teduglutide Treatment Response for Pediatric SBS-IF, With Valeria Cohran, MD