Prehospital management of pain associated with acute complications of Sickle Cell Disease: a preliminary nationwide cross-sectional study.

OBJECTIVE

We aimed to describe the epidemiology of emergency medical services (EMS) encounters for sickle cell disease (SCD) complications, assess clinical practice patterns, and evaluate factors that may be associated with analgesia administration for SCD-related pain throughout the US.

METHODS

We completed a cross-sectional analysis using a nationwide sample of 9-1-1 advanced life support encounters during 2023 where the EMS clinician impression indicated complications of sickle cell disease. Outcomes of interest included pain scale measurements, pain management, and naloxone administration. Descriptive statistics were computed and stratified by key patient- and encounter-related factors.

RESULTS

Among a total of 10,023 EMS encounters for SCD complications, 5.2% were pediatric, 48.6% were female, and 94.2% took place in urban settings. Median patient contact time was 22.2 min (IQR: 15.4-31.0). Pain scale measurements were documented in 73.0% of encounters and analgesia of any kind was administered in 13.5% of cases, including opioids in 11.7%. Naloxone administration was rare (<0.1%). Among patients whose pain scale was ≥7/10, encounters where patient contact lasted 20 min or greater had intravenous access established nearly five-times more often and received any analgesia or opioids roughly ten-times more often.

CONCLUSIONS

In this large nationwide sample of EMS encounters for SCD complications, we found that administration of analgesia occurred more often during encounters with longer EMS-patient contact. However, low rates of pain control in all cases leaves room for improvement in EMS management of SCD-related pain, perhaps via intranasal analgesia.