JAMA Pediatr

Timely opioid dosing in pediatric sickle cell pain reduces hospitalizations

September 12, 2025

Study details: A multisite cross-sectional analysis was conducted using the Pediatric Emergency Care Applied Research Network Registry, encompassing 9,233 ED visits for uncomplicated sickle cell disease (SCD) pain in children under 19 years across 12 U.S. pediatric hospitals (2019–2021). The exposures were time to first opioid (≤60 vs. >60 minutes from arrival) and interval between first and second opioid doses (≤30, ≤45, ≤60 minutes vs. longer).

Results: Hospitalization occurred in 54.4% of visits. First-dose opioid administration within 60 minutes was associated with reduced odds of hospitalization (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.75–0.95). Among visits with ≥2 opioid doses, timely first-dose administration remained protective even if the second dose was delayed. The greatest reduction in admissions was observed when both the first dose was given within 60 minutes and the second within 30 minutes (OR, 0.62; 95% CI, 0.52–0.75), with benefit persisting for second doses up to 60 minutes.

Clinical impact: These findings provide robust evidence that rapid opioid administration, especially delivering the first dose within 60 minutes and the second within 30 minutes, substantially reduces hospitalization rates for pediatric SCD pain. This supports and refines current recommendations for prompt, repeated opioid dosing in the ED for acute SCD pain management.

Source:

Gwarzo I, et al. (2025, September 2). JAMA Pediatr. Opioid Timeliness in the Emergency Department and Hospitalizations for Acute Sickle Cell Pain. https://pubmed.ncbi.nlm.nih.gov/40892426/