Evaluation of Individualized Pain Plans for Children With Sickle Cell Disease Admitted for Vaso-occlusive Crisis at Riley Hospital for Children

Abstract

OBJECTIVE Vaso-occlusive crisis (VOC) is the most common problem reported by patients with sickle cell disease (SCD). The objective of this study was to evaluate the impact of individualized pain plans in pediatric patients with SCD admitted for VOC. METHODS This was a pre- and post-study of patients with SCD admitted to Riley Hospital for Children for VOC from July 1, 2019, through July 1, 2020. The primary outcome was length of inpatient stay for VOC. Secondary outcomes included final pain score, days on scheduled opioids, days on breakthrough opioids, and average morphine milligram equivalents (MME) used per day. RESULTS Nine patients were included. The mean age was 16 years (range, 10–20 years). Key clinical findings were decreases in median [IQR] for final pain scores (7 [4.5–9] vs 6 [2.5–8], p = 0.396) and number of days of breakthrough opioid use (5 [3–8] vs 4 [2.5–5.5], p = 0.233). Following implementation of an individualized pain plan, there was an increase in median average MME per day (65.94 [53.1–97.7] vs 82.85 [41–114.3], p = 0.844). Median length of stay and days on scheduled opioids remained the same. CONCLUSIONS This study demonstrated that use of individualized pain plans in a small population of patients with SCD might result in decreased pain scores and decreased days on breakthrough opioids.