Urgency of Emergency Department Visits by Children with Sickle Cell Disease

Children with sickle cell disease (SCD) visit the emergency department (ED) more than children without SCD. But are they simply using the ED for more non-urgent care?

Researchers looked at ED visits by children 18 years and younger to 48 Maryland EDs for asthma, diabetes and SCD. They chose those conditions as three that are amenable to home or non-urgent ambulatory care as a way to prevent non-urgent ED visits. Complications from the conditions, however, do require episodic acute care and ED-based evaluation and treatment.

Overall ED visits resulted in admission 4.3 percent of the time. Children with asthma, diabetes or SCD were admitted 14 percent of the time. Visits for SCD were most likely to result in admission (45%) compared to diabetes (41%) or asthma (12%).

Cases were coded for complexity and use of resources (laboratory, radiology, electroencephalogram, electrocardiogram) measured, confirming that urgent visits were more likely necessary for diabetes and SCD than for asthma.

For a variety of reasons, SCD, which can be painful, has been stigmatized as a disease that results in overuse of the ED for pain-seeking medications. This is unwarranted, the authors write, and “in light of the present data, should be further discredited.”