Early vs delayed opioid administration for pediatric sickle cell vaso-occlusive crisis: A systematic review and meta-analysis - 11/06/26
, Alexandra Salazar Riaño b, Jonathan D. Mohnkern c, Marwa Ibrahim d, Vedanti Dave e, Joshua Hess f, Paul T. Finch f, Thaís S. Martins Shehan gAbstract |
Importance |
Sickle cell disease is frequently complicated by vaso-occlusive events, which represent one of the leading causes of acute pain and emergency care utilization in pediatric patients. However, there is limited and inconsistent data about the time to administer opioids in pediatric patients with sickle cell vaso-occlusive episodes (VOE).
Objective |
We aim to conduct a systematic review and meta-analysis to compare early and delayed opioid administration in pediatric patients with VOE.
Data sources |
We systematically searched PubMed, Embase, and Cochrane Library from inception to November 2025.
Studies selection |
Randomized controlled trials or observational studies comparing early and delayed opioid administration in pediatric patients with sickle cell VOE. Five reviewers independently screened titles and abstracts, followed by full-text evaluation of potentially eligible articles. Disagreements were resolved through discussion and adjudication by a third reviewer.
Data extraction and synthesis |
We followed PRISMA guidelines. Data were independently extracted by multiple reviewers.
Main outcomes and measures |
Our main endpoint was hospital admission from the index emergency department (ED) visit. Additional endpoints included ED discharge, ED length of stay, and pain reassessment. Risk ratios (RRs) were calculated for binary outcomes and mean differences (MDs) or standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CIs). We performed a random-effect meta-analysis for all outcomes using R software (version 4.3.2).
Results |
Six studies comprising 3367 patients were included, of whom 67% received early and 32% delayed opioid. The mean age was 9–16 years, and males accounted for 50% of participants. There was no significant difference when comparing early vs delayed opioid administration for hospital admission (RR 0.96; 95% CI 0.85 to 1.10), ED discharge (RR 1.04, 95% CI 0.89 to 1.22), ED length of stay (MD -6.02 min; 95% CI -1.22,45 to 110.42) and pain reassessment (SMD 0.85; 95% CI -1.92 to 3.63). A subgroup analysis comparing ≤60 min with ≥60 min of opioids administration also showed no difference between intervention arms. Individual studies showed potential benefits with timely repeat opioid dosing and the use of intranasal fentanyl (INF).
Conclusions and relevance |
Our analysis showed no difference comparing early and delayed opioid administration in pediatric patients with sickle cell related VOE across hospital admission, ED discharge, ED length of stay, and pain reassessment.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Question: Does early opioid administration improve hospitalization rates or pain-related outcomes in children with sickle cell disease presenting with vaso-occlusive episodes? |
• | Findings: In this systematic review and meta-analysis of pediatric emergency department visits for sickle cell vaso-occlusive pain, earlier opioid administration did not reduce hospital admission rates across studies compared to delayed. However, findings suggest a potential benefit with timely repeat opioid dosing and the use of intranasal fentanyl, which were associated with improved pain control and higher likelihood of emergency department discharge in individual studies. |
• | Meaning: Although opioid administration within 60 min remains an important quality-of-care benchmark reflecting patient-centered management, this study suggests it may not be the sole or primary driver of hospitalization risk in children presenting with sickle cell vaso-occlusive episodes. Hospitalization outcomes are likely multifactorial and may be more strongly influenced by adherence to structured pain pathways. |
Keywords : Sickle cell disease, Vaso-occlusive crisis, Pediatric emergency medicine, Opioid analgesia, Expert consensus, meta-analysis
Abbreviations : CI, CNS, ED, HbSS, I 2 , INF, MD, NHLBI, PRISMA, RR, RoB, SCD, VOE
Plan
Vol 107
P. 94-100 - septembre 2026 Retour au numéro
Article précédent
- Structural brain lesions and delirium in geriatric emergency department patients: A matched case-control study
- Dylan A. Glawe, Anthony Marincovich, Taeuk Kang, Eric Kontowicz, Matthew Howard, Sangil Lee
- Closing gaps in urban trauma systems: Outcomes of an inner-city community emergency department multidisciplinary trauma protocol
- Kory S. London, Alan Cherney, Sulabh Neupane, H. Alex Tomlinson, Joseph Cervone, Elaine Qian, Casey Fishman, Jennifer Davis, Sean McGann, Varsha Goswami, George Koenig, Frederick Randolph
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?