128 - Pain Outcomes in Children with Sickle Cell Disease Reported via Texting following Emergency Department Discharge for Acute Pain Events

Publication Number: 2123.128

Keli Coleman, Medical College of Wisconsin, Milwaukee, WI, United States; Amanda M.. Brandow, Medical College of Wisconsin, Milwaukee, WI, United States; Sheikh (Iqbal) I. Ahamed, Marquette University,, Milwaukee, WI, United States; Ruta Brazauskas, Medical College of Wisconsin, MILWAUKEE, WI, United States; David Brousseau, Nemours Children's Hospital, Wilmington, DE, United States; Amy L. Drendel, Medical College of Wisconsin, MIlwaukee, WI, United States

Background: Children with sickle cell disease (SCD) have severe acute pain resulting in high emergency department (ED) utilization and frequent ED returns (~29%) within 14 days of discharge home. The at-home pain experience for these children after ED discharge is largely unexplored.

Objective: To evaluate the pain and functional outcomes for children with SCD treated in the ED for acute pain and discharged home.

Design/Methods: A convenience sample of children 5-17.95 years with SCD and their parents were prospectively enrolled. Both could receive secure daily text messages for 14 days following discharge to report maximum daily pain severity (0-10 rating scale; 0-1 no pain; 2-5 mild pain; 6-7 moderate pain, 8-10 severe pain) and daily function (performing usual activities? yes/no). Date of ED return was abstracted from the electronic health record. If both parent and child responded, the child's report was used. Descriptive analyses were performed.

Results: At home data was collected on 56 subjects. Children were 50% female, and median age was 9 years (range 5-17).

During the first week after ED discharge, 32 (57%) texted at least 1 pain score (Figure 1); 19% reported severe pain and 44% moderate pain for at least 1 day. The highest pain scores were reported during days 1- 3 (Figure 2). During the first week after ED discharge, 33 (59%) texted at least 1 functional status; 36% reported limitations for at least 1 day (Figure 3).

We found 13 (23%) had an ED return visit within 14 days of ED discharge, including 5 children within 3 days and 7 within 7 days. In addition, 62% of the children with an ED return never texted any pain/functional outcomes. Only 4 (31%) participants texted pain severity on the day before ED return. Of those texting outcomes, the proportions with an ED return were no different for those with severe pain (4/26, 15%) compared to those who did not report severe pain (1/6, 17%) (p=1).

Conclusion(s): Children with SCD treated and discharged home from the ED reported moderate/severe pain and dysfunction at home, particularly during days 1-3. The rate of returning to the ED was similar between those who did and did not report severe pain. However, high rates of text missingness may introduce bias into this assessment of the home experience.

Figure 1. Daily Maximum Pain Score Reported by Texting Respondent
Text Question: What was your/your child's highest pain score today?

Figure 2. Distribution of Pain Severity Scores Reported by Day Following ED discharge for SCD Acute Pain


Figure 3. Child's Functional Assessment by Day Following ED Discharge for Acute Sickle Cell Pain
Text Question: Did you do the things you normally do?