LAUSR

put forth guidelines to direct the care of patients presenting with VOE. 3 Key guideline recommendations include: (1) triage as high priority with rapid evaluation of patients presenting with VOE, (2) use of parenteral opioids for moderate-to-severe pain with administration ≤ 30 min after ED triage or ≤ 60 min after registration, (3) pain reassessment and subsequent parenteral opioid dosing every 15 – 30 min until pain is controlled, (4) the administration of non-steroidal anti-inflammatory drugs (NSAIDS) as an analgesic adjuvant (if no contraindications exist), and (5) in euvolemic patients with SCD-VOE who are unable to drink fluids, intravenous hydration at no more than maintenance rate to avoid over-hydration. Our objective was to assess adherence to all NHLBI recommendations and the impact of timely opioid administration on hospital admission in a study of 20 academic pediatric EDs in the United States and Canada. A cross-sectional study was performed at 20 academic, pediatric EDs across the United States and Canada (19 in the United States and one in Canada) (Supplemental Methods). International Classification of Disease Ninth and Tenth Revision code ED diagnoses of VOE were used to identify consecutive patients. To include the traditionally more severe genotypes of SCD, children with sickle cell anemia (hemoglobin-SS disease or hemoglobin S β o -Thalassemia) aged 3 – 21 years who presented with VOE pain of any severity were included.