# Factors associated with early return visits to the emergency department in patients with vaso-occlusive crisis

## TL;DR

This study found that nearly 40% of sickle cell patients return to the emergency department within 72 hours after being treated for severe pain, with unclear reasons for the high rate.

## Contribution

The study provides the first detailed analysis of early emergency department revisits for vaso-occlusive crisis in Saudi Arabia's adult sickle cell population.

## Key findings

- 39.2% of patients returned to the ED within 72 hours after VOC treatment.
- Direct bilirubin levels and time to first opioid dose were the only factors associated with early return visits.
- The revisit rate is higher than international reports, suggesting issues with current ED management practices.

## Abstract

One of the most common presentations of sickle cell disease (SCD) in the emergency department (ED) is acute severe pain episodes due to a vaso-occlusive crisis (VOC). Management of these episodes is primarily through intravenous pain control, but patients often return to the ED with the same complaint a few days after discharge. While some global studies have explored the risk factors for ED revisits due to VOC, the literature is lacking in the adult population, specifically in Saudi Arabia where SCD prevalence is high. The goal of this study is to measure the incidence of ED 72-hour early revisit (ERV) among SCD patients due to a VOC episode and to identify factors that might be associated with an ERV in this population. We conducted a retrospective cohort study using the electronic medical records, retrieving all patients who presented to the ED with a VOC from the period of 2017 to 2022.

This study included 120 VOC visits. The percentage of 72-hour ERV to the ED among VOC patients was 39.2%, in which 91.5% received opioids, and 31.9% were admitted during the return visit. Return visitors’ median age was 29, most of them were male. There was no statistically significant correlation found between the patients’ 72-hour ERV to the ED and their age, gender, comorbidities, history of exchange transfusion, pain score, or dose of opiates received. Of the variables measured at the index visit only the direct bilirubin level, and time to first opioid dose was associated with 72-hour ERV with an OR of 1.08 (95%CI: 1.0 to 1.16, P = 0.022) and 0.99 (95%CI: 0.99 to 0.99, P = 0.012) respectively.

We found that 39.2% of VOC episodes discharged from the ED had an ERV. This rate is higher than what is reported internationally. Additionally, the lack of clear predictors for revisits raises doubts regarding the efficacy of the ED ‘’treat and release’’ approach in this population.

Not applicable.

The online version contains supplementary material available at 10.1186/s12873-025-01192-1.