Long Delays in Emergency Pain Care for Individuals with Sickle Cell Disease

People living with sickle cell disease often face significant delays in receiving pain relief when visiting emergency departments during a vaso-occlusive crisis (VOC), a severe pain episode caused by blocked blood flow. A recent study published in Blood Advances highlights that many patients are not being properly triaged according to national guidelines, resulting in longer wait times for pain medication.

The research revealed that patients assigned a lower severity score, specifically those categorized as ESI 3, waited nearly three times longer to receive pain relief compared to those classified with a higher severity score, ESI 2. On average, patients with ESI 2 received their first dose of pain medication in about 65 minutes, while those with ESI 3 waited up to 178 minutes. Alarmingly, some patients left the emergency department before receiving any medication after waiting over 5 hours.

Pain management is critical for sickle cell patients, as VOC can cause excruciating pain likened to the tightening of a tourniquet. The study analyzed 66 emergency visits by 41 patients over six months at the University of Maryland Medical Center. Most patients (63.4%) had the severe HbSS sickle cell variant, and the median age was 33 years. Patients with a higher triage severity score (ESI 2) were about six times more likely to receive prompt pain relief.

Current guidelines recommend that sickle cell patients should receive their first dose of pain medication within 60 minutes of ED arrival, with reassessment every 30-60 minutes. The findings suggest that improper triage can significantly delay pain management, negatively impacting patient care and experience.

The research emphasizes the importance of correct triage scoring, such as the Emergency Severity Index (ESI), to ensure timely treatment. Limitations of the study include its retrospective design and single-center setting, which may not reflect practices at other hospitals. The authors aim to expand their research and explore how triage scores influence overall patient satisfaction and hospitalization outcomes.

Advocacy efforts continue to focus on implementing quality measures that improve timely pain management for sickle cell patients across healthcare facilities. Ensuring proper triage is a vital step toward reducing unnecessary suffering and improving emergency care for this vulnerable population.

For more information, see the study: Use of Emergency Severity Index 2 Reduces Time to First Analgesia in Sickle Cell Disease Vaso-occlusive Crisis, Blood Advances (2025). Source: https://medicalxpress.com/news/2025-10-individuals-sickle-cell-disease-delays.html