Impact of a Pediatric Sickle Cell Outpatient Pain Clinic on Health Outcomes

▪ Over a one-year period at our institution, we identified over 350 emergency department (ED) visits for acute sickle cell pain, with 100 of these acute pain events resulting in hospital admission. While the NIH SCD Management guidelines recommend rapid initiation of analgesia, achieving this metric is challenging in a busy ED setting. Our personal challenge in meeting this rapid analgesic recommendation in our ED prompted our decision to develop an outpatient pain clinic aimed to reduce the time to initial opioid administration and decrease the hospital admission rate for acute pain events. In addition to opioids, relaxation training delivered via virtual reality (VR) is a distraction technique shown to alleviate the pain and anxiety associated with acute and chronic pain. We hypothesized that children and adolescents with SCD presenting with acute pain to our outpatient pain clinic would receive quicker pain management and have a lower rate of admission. In addition, we tested the hypothesis that virtual reality delivered relaxation training would be acceptable in the acute pain setting. Methods. We compared SCD pain outcomes for patients evaluated in the outpatient pain clinic versus the ED at Children's of Alabama. We abstracted the exact times for triage, time the first dose of NSAID and opioid were ordered and time the first NSAID and opioids were administered from the electronic medical records to determine the time to first opioid from triage for all outpatient pain clinic visits and the most recent ED visit. The dose of NSAID (mg) and opioid (mg/kg) was recorded. The administration and timing of repeated opioid dosing, total time receiving care, and hospitalization were recorded. VR was offered to the patients that presented to the outpatient pain clinic but was not offered to any ED patient. We analyzed differences between all encounters in the pain clinic and ED using t-test for continuous variables and Fisher's exact for categorical outcomes. We then performed a matched-pair analysis to account for repeat patients using only the first pain clinic visit and most recent ED visit using a Wilcoxon Signed Rank test to account for possible non-normal distribution in this small study. Results. We identified 21 patients presenting to the outpatient pain clinic accounting for 27 pain clinic visits. Fifteen patients have a clinical diagnosis of HbSS, 3 with HbSB0 thalassemia, and 6 with HbSC. Only two (7%) of the 27 pain clinic visits resulted in an admi