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 sickle cell disease (SCD) pain.1

The findings were presented at the 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.1

“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 HCPLive. “Our goal was to determine if we could predict which patients were going to return so that we could potentially intervene.”1

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.1,2

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).1

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.1

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.1

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%.1

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.1

“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.

References

1. 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.

2. World Health Organisation. Sickle-cell disease. Who.int. Published August 6, 2025. https://www.who.int/news-room/fact-sheets/detail/sickle-cell-disease