• Posted October 10, 2025

Poor ER Triage Leaves Sickle Cell Patients In Agony For Hours, Experts Say

Patients experiencing a sickle cell crisis can wind up waiting hours in agony if inappropriately triaged by ER staff, a new study says.

Patients misplaced in a less severe pain category waited nearly three times as long for their first dose of pain medication compared to those assessed properly, researchers reported Oct. 7 in the journal Blood Advances.

Worse, two-thirds of patients received this inaccurate triage of their pain, and no patients received timely treatment within guidelines, results showed.

Pain crisis — also called vaso-occlusive crisis (VOC) — occurs with a person’s sickled cells stick together and build up in a blood vessel, blocking blood supply to tissues and organs.

“Many patients describe VOC as the worst pain of their lives,” senior researcher Dr. Jennie Law, a hematologist-oncologist and associate professor at the University of Maryland School of Medicine, said in a news release. “They sometimes compare it to the feeling you’d get from taking a tourniquet to your limb and tightening it.”

National Institutes of Health guidelines recommend assigning an Emergency Severity Index (ESI) level 2 to patients in a sickle cell crisis, researchers said in background notes.

It’s the second-highest triage ranking a patient can receive, and guidelines say these patients should be given painkillers within 30 minutes of triage or 60 minutes of registration, researchers said.

“Pain is a significant burden in the day-to-day lives of those living with sickle cell disease, with VOC being the number one reason these patients present to the emergency department,” said lead researcher Dr. Abdulaziz Abu Haimed, a former internal medicine resident at the University of Maryland Medical Center.

“When these patients arrive, they really need help, and as soon as possible,” Abu Haimed said in a news release.

For the study, researchers tracked 41 patients who appeared at the University of Maryland Medical Center’s emergency department 66 times over a six-month period for sickle cell crisis.

During the visits, the inappropriate lower ranking of ESI 3 was assigned 65% of the time, and the accurate ESI 2 ranking 35% of the time.

The median time to first dose of pain medication for those assigned ESI 2 was 65 minutes, versus 178 minutes for those assigned ESI 3, results showed. Median means half more time, half took less.

Four patients wound up leaving the ER without receiving any pain meds, after a median wait of 349 minutes — nearly six hours. All of these patients had been assigned ESI 3.

None of patients fell within the recommended treatment time range outlined by NIH guidelines, researchers said.

“A patient with sickle cell disease assigned an ESI 2 compared to 3 is about six times more likely to receive pain medication quicker,” Abu Haimed said. “Ensuring we assign patients the recommended ESI is one small intervention that can significantly improve the quality of care and overall experience in the emergency department.”

Researchers plan to validate their study in a follow-up with a larger group of patients.

More information

The Cleveland Clinic has more on sickle cell crisis.

SOURCE: American Society of Hematology, news release, Oct. 8, 2025