https://orcid.org/0000-0001-8115-7824
Key Points
In 44 US children’s hospitals from 2016 to 2023, ketamine administration increased during admissions for youth with sickle cell disease.
Early (3 days) ketamine administration was associated with decreased length of stay and days on intravenous opioids.
Ketamine is recommended as an opioid-sparing adjunct for sickle cell disease (SCD)-related pain management. Little is known regarding its use in hospitalized youth with SCD. We aimed to describe trends in ketamine administration and examine associations between ketamine administration and outcomes in hospitalized youth with SCD. We conducted a cross-sectional, multicenter study examining hospital admissions for youth with SCD from 44 children's hospitals in the US from 2016- 2023. Youth aged ≥6 months and older with SCD were identified using ICD-10 codes. Exposures included age, sex, race, payor, childhood opportunity index, hydroxyurea administration, and concomitant methadone, buprenorphine, or gabapentinoid administration. The primary outcome was ketamine administration during admission. Secondary outcomes included length of stay, days on intravenous opioids, all-cause 14-day readmission rates, and intensive care unit stays during admissions with ketamine administered during the first three days of hospitalization (early) and hospital day 4 or later (late). From 2016-2023, 4.5% (n = 3,391) of admissions for patients with SCD included ketamine administration, with prevalence increasing from 2.3% in 2016 to 5.7% in 2023 (p<0.001). Age groups ≥12 years and year of 2019 or later was associated with increased odds of ketamine administration. Admissions with ketamine administration were also more likely to have administration of methadone and hydroxyurea. Early versus late ketamine administration was associated with shorter LOS and fewer parental opioid days, indicating randomized controlled studies are needed to determine not only which patients benefit from ketamine but also the impact of early administration.
