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BackgroundHigh return visit rates after hospitalization for people with sickle cell disease (SCD) have been previously established. Due to a lack of multicenter emergency department (ED) return visit rate data, the return visit rate following ED discharge for pediatric SCD pain treatment is currently unknown.ProcedureA seven‐site retrospective cohort study of discharged ED visits for pain by children with SCD was conducted using the Pediatric Emergency Care Applied Research Network Registry. Visits between January 2017 and November 2021 were identified using previously validated criteria. The primary outcome was the 14‐day return visit rate, with 3‐ and 7‐day rates also calculated. Modified Poisson regression was used to analyze associations for age, sex, initial hospitalization rate, and a visit during the COVID‐19 pandemic with return visit rates.ResultsOf 2548 eligible ED visits, approximately 52% were patients less than 12 years old, 50% were female, and over 95% were non‐Hispanic Black. The overall 14‐day return visit rate was 29.1% (95% confidence interval [CI]: 27.4%–30.9%; site range 22.7%–31.7%); the 7‐ and 3‐day return visit rates were 23.0% (95% CI: 21.3%–24.6%) and 16.7% (95% CI: 15.3%–18.2%), respectively. Younger children had slightly lower 14‐day return visit rates (27.3% vs. 31.1%); there were no associations for site hospitalization rate, sex, and a visit occurring during the pandemic with 14‐day returns.ConclusionNearly 30% of ED discharged visits after SCD pain treatment had a return visit within 14 days. Increased efforts are needed to identify causes for high ED return visit rates and ensure optimal ED and post‐ED care.

Introduction: After discharge from the emergency department (ED), pain management challenges parents, who have been shown to undertreat their children’s pain. Our goal was to evaluate the effectiveness of a five-minute instructional video for parents on pain treatment in the home setting to address common misconceptions about home pediatric pain management. Methods: We conducted a randomized, single-blinded clinical trial of parents of children ages 1-18 years who presented with a painful condition, were evaluated, and were discharged home from a large, tertiary care pediatric ED. Parents were randomized to a pain management intervention video or an injury prevention control video. The primary outcome was the proportion of parents that gave their child pain medication at home after discharge. These data were recorded in a home pain diary and analyzed using the chi square test to determine significant difference. Parents’ knowledge about components of at-home pain treatment were tested before, immediately following, and two days after intervention. We used McNemar’s test statistic to compare incorrect pretest/correct post-test answers between intervention and control groups. Results: A total of 100 parents were enrolled: 59 parents watched the pain education video, and 41 the control video. Overall, 75% of parents completed follow-up, providing information about home medication use. Significantly more parents provided pain medication to their children after watching the educational video: 96% vs 80% (difference 16%; 95% CI 7.8-31.3%). Significantly more parents had correct pain treatment knowledge immediately following the educational video about pain scores (P = 0.04); the positive effects of analgesics (P <0.01); and pain medication misconceptions (P = 0.02). Most differences in knowledge remained two days after the video intervention. Conclusion: The five-minute educational video about home pain treatment viewed by parents in the ED prior to discharge significantly increased the proportion of children receiving pain medication at home as well as parents’ knowledge about at-home pain management.

Multisystem inflammatory syndrome in children is an emerging pediatric illness associated with severe acute respiratory syndrome coronavirus 2 infection. The syndrome is rare, and evidence-based guidelines are lacking. This report reviews a patient who presented for medical care multiple times early in the course of his illness, thus offering near-daily documentation of symptoms and laboratory abnormalities. The patient did not have thrombocytopenia, anemia, or myocardial inflammation until the fifth day of fever. These laboratory abnormalities coincided with the onset of rash, conjunctival injection, vomiting, and diarrhea: clinical signs that could serve as indicators for when to obtain blood tests. The timing of this patient’s onset of multisystem involvement suggests that testing for multisystem inflammatory syndrome in children after only 24 h of fever, as the Centers for Disease Control and Prevention recommends, may yield false-negative results. Testing for multisystem inflammatory syndrome in children after 4 days of fever may be more reliable.

To the Editor, Sickle cell disease (SCD) is the most common inherited blood disorder.In the United States, there are an estimated 90 000 people living with SCD and approximately 40% are children. 1 The sickling of abnormal hemoglobin in red blood cells can lead to painful vaso-occlusive crises, resulting in many emergency department (ED) visits and hospitalizations. 2 Previous data have shown high rates of rehospitalization or return to the ED after an inpatient hospitalization for people with SCD, 2 but there is limited evidence pertaining to return visits for children after discharge from an ED visit for acute SCD pain. Therefore, we sought to determine the frequency of return visits, assess factors associated with return visits, and to describe institutional variation in hospitalization and revisit rates for children treated and discharged from the ED with uncomplicated SCD pain crises.We performed a retrospective cohort study of 40 hospitals in the Pediatric Health Information System (PHIS; Supporting Information Appendix S1), analyzing ED encounters for uncomplicated sickle cell pain episodes for patients <19 years of age between 2017 and 2021. We included children with International Classification of Diseases TenthRevision discharge diagnosis of SCD (D57.x, except D57.3) who were treated with a parenteral opioid medication. We excluded encounters with complications, defined as encounters with a diagnosis for acute chest syndrome or priapism, and encounters with charges for both a parenteral antibiotic and a blood culture as a surrogate marker for fever.We calculated the number and percentage of index ED encounters with a revisit at 3, 7, and 14 days. We classified each revisit as either an ED revisit or hospitalization, as well as whether it was a revisit for any reason or for an uncomplicated pain episode (using same criteria as study inclusion). To evaluate variation by institution, we summarized the number of encounters, index visit admission rate, and 14-day return visit rate for each hospital. Hospital admission rate was defined as the