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This study assessed the variability in use of intravenous fluids (IVFs), and the association of normal saline bolus (NSB), on pain and other clinical outcomes in children with SCA, presenting to pediatric emergency departments (PED) with VOE. Four\u2010hundred charts of children age 3\u201021\u2009years with SCA\/VOE receiving parenteral opioids at 20 high\u2010volume PEDs were evaluated in a retrospective study. Data on type and amount of IVFs used were collected. Patients were divided into two groups: those who received NSB and those who did not. The association of NSB use on change in pain scores and admission rates was evaluated. Among 400 children studied, 261 (65%) received a NSB. Mean age was 13.8 \u00b1 4.9 years; 46% were male; 92% had hemoglobin\u2010SS. The IVFs (bolus and\/or maintenance) were used in 84% of patients. Eight different types of IVFs were utilized and IVF volume administered varied widely. Mean triage pain scores were similar between groups, but improvement in pain scores from presentation\u2010to\u2010ED\u2010disposition was smaller in the NSB group (2.2 vs 3.0, <jats:italic>P<\/jats:italic> =\u2009.03), while admission rates were higher (71% vs 59%, <jats:italic>P<\/jats:italic> =\u2009.01). Use of NSB remained associated with poorer final pain scores and worse change in pain scores in our multivariable model. In conclusion, wide variations in practice utilizing IVFs are common. NSB is given to &gt;50% of children with SCA\/VOE, but is associated with poorer pain control; a controlled prospective trial is needed to determine causality.<\/jats:p>","DOI":"10.1002\/ajh.25471","type":"journal-article","created":{"date-parts":[[2019,3,28]],"date-time":"2019-03-28T00:17:14Z","timestamp":1553732234000},"page":"689-696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Normal saline bolus use in pediatric emergency departments is associated with poorer pain control in children with sickle cell anemia and vaso\u2010occlusive pain"],"prefix":"10.1002","volume":"94","author":[{"given":"Marcus A.","family":"Carden","sequence":"first","affiliation":[{"name":"Departments of Pediatrics and Medicine University of North Carolina at Chapel Hill School of Medicine  Chapel Hill North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C.","family":"Brousseau","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Medical College of Wisconsin  Milwaukee Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahd A.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Washington University School of Medicine  St. Louis Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Bennett","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Alfred I. DuPont Hospital for Children  Wilmington Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seema","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center  Cincinnati Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Bogie","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Oklahoma Health Sciences Center  Oklahoma City Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's National Medical Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theron Charles","family":"Casper","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care, University of Utah  Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura L.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Alpert Medical School Brown University  Providence Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corrie E.","family":"Chumpitazi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Baylor College of Medicine  Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Nationwide Children's Hospital  Columbus Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlton","family":"Dampier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Hematology\/Oncology Emory University School of Medicine  Atlanta Georgia"},{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, The Aflac Cancer and Blood Disorders Center of Children's Healthcare  Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela M.","family":"Ellison","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, The Children's Hospital of Philadelphia  Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hartmut","family":"Grasemann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert W.","family":"Hickey","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh of UPMC  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3156-2378","authenticated-orcid":false,"given":"Lewis L.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology and Oncology University of Illinois at Chicago  Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Leibovich","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, UCSF\u2010Benioff Children's Hospital at Oakland  Oakland California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Powell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Richards","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care, University of Utah  Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syana","family":"Sarnaik","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Michigan  Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debra L.","family":"Weiner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Boston Children's Hospital  Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6019-2858","authenticated-orcid":false,"given":"Claudia 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