Analgesic Use Among Adults with a Trauma-Related Emergency Department Visit: A Retrospective Cohort Study from Alberta, Canada.

Administrative data Analgesia Emergency department Retrospective

Journal

Pain and therapy
ISSN: 2193-8237
Titre abrégé: Pain Ther
Pays: New Zealand
ID NLM: 101634491

Informations de publication

Date de publication:
Aug 2023
Historique:
received: 22 03 2023
accepted: 25 04 2023
medline: 3 6 2023
pubmed: 3 6 2023
entrez: 3 6 2023
Statut: ppublish

Résumé

A better understanding of current acute pain-driven analgesic practices within the emergency department (ED) and upon discharge will provide foundational information in this area, as few studies have been conducted in Canada. Administrative data were used to identify adults with a trauma-related ED visit in the Edmonton area in 2017/2018. Characteristics of the ED visit included time from initial contact to analgesic administration, type of analgesics dispensed during and upon being discharged home directly from the ED (≤ 7 days after), and patient characteristics. A total of 50,950 ED visits by 40,505 adults with trauma were included. Analgesics were administered in 24.2% of visits, of which non-opioids were dispensed in 77.0% and opioids were dispensed in 49.0%. Time to analgesic initiation occurred more than 2 h after first contact. Upon discharge, 11.5% received a non-opioid and 15.2% received an opioid analgesic, among whom 18.5% received a daily dose ≥ 50 morphine milligram equivalents (MME) and 30.2% received > 7 days of supply. Three hundred and seventeen adults newly met criteria for chronic opioid use after the ED visit, among whom 43.5% received an opioid dispensation upon discharge; of these individuals, 26.8% had a daily dose ≥ 50 MME and 65.9% received > 7 days of supply. Findings can be used to inform optimization of analgesic pharmacotherapy practices for the treatment of acute pain, which may include reducing the time to initiation of analgesics in the ED, as well as close consideration of recommendations for acute pain management upon discharge to provide ideal patient-centered, evidence-informed care.

Identifiants

pubmed: 37269501
doi: 10.1007/s40122-023-00521-1
pii: 10.1007/s40122-023-00521-1
pmc: PMC10289951
doi:

Types de publication

Journal Article

Langues

eng

Pagination

1039-1053

Informations de copyright

© 2023. The Author(s).

Références

Tanabe P, Buschmann M. A prospective study of ED pain management practices and the patient's perspective. J Emerg Nurs. 1999;25(3):171–7.
Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002;20(3):165–9.
doi: 10.1053/ajem.2002.32643 pubmed: 11992334
Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, et al. Pain in the emergency department: results of the Pain and Emergency Medicine Initiative (PEMI) Multicenter Study. J Pain. 2007;8(6):460–6.
doi: 10.1016/j.jpain.2006.12.005 pubmed: 17306626
Ahmadi A, Bazargan-Hejazi S, Heidari Zadie Z, Euasobhon P, Ketumarn P, Karbasfrushan A, et al. Pain management in trauma: a review study. J Injury Violence Res. 2016;8(2):89–98.
Anekar AA, Cascella M. WHO Analgesic Ladder. StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.; 2022.
Preuss CV, Kalava A, King KC. Prescription of controlled substances: benefits and risks. StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.; 2022.
Raub JN, Vettese TE. Acute pain management in hospitalized adult patients with opioid dependence: a narrative review and guide for clinicians. J Hosp Med. 2017;12(5):375–9.
doi: 10.12788/jhm.2733 pubmed: 28459910
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.
doi: 10.1016/S0140-6736(07)61602-X
Canadian Institute for Health Information. Opioid prescribing in Canada: how are practices changing? Ottawa, Ontario: CIHI; 2019.
Sullivan MD, Edlund MJ, Zhang L, Unützer J, Wells KB. Association between mental health disorders, problem drug use, and regular prescription opioid use. Arch Intern Med. 2006;166(19):2087–93.
doi: 10.1001/archinte.166.19.2087 pubmed: 17060538
Bahorik AL, Satre DD, Kline-Simon AH, Weisner CM, Campbell CI. Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated health care system. J Addict Med. 2017;11(1):3–9.
doi: 10.1097/ADM.0000000000000260 pubmed: 27610582 pmcid: 5291754
Rice JB, White AG, Birnbaum HG, Schiller M, Brown DA, Roland CL. A model to identify patients at risk for prescription opioid abuse, dependence, and misuse. Pain Med. 2012;13(9):1162–73.
doi: 10.1111/j.1526-4637.2012.01450.x pubmed: 22845054
National Institutes on Drug Abuse (US). Common comorbidities with substance use disorders research report. Bethesda, MD; 2020.
Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–9.
doi: 10.1097/01.mlr.0000182534.19832.83 pubmed: 16224307
Tian TY, Zlateva I, Anderson DR. Using electronic health records data to identify patients with chronic pain in a primary care setting. J Am Med Inform Assoc. 2013;20(E2):E275–80.
doi: 10.1136/amiajnl-2013-001856 pubmed: 23904323 pmcid: 3861913
Tonelli M, Wiebe N, Fortin M, Guthrie B, Hemmelgarn BR, James MT, et al. Methods for identifying 30 chronic conditions: application to administrative data. BMC Med Inform Decis Mak. 2015;15:31.
doi: 10.1186/s12911-015-0155-5 pubmed: 25886580 pmcid: 4415341
Lurie N, Popkin M, Dysken M, Moscovice I, Finch M. Accuracy of diagnoses of schizophrenia in Medicaid claims. Hosp Commun Psychiatry. 1992;43(1):69–71.
Kolodner K, Lipton RB, Lafata JE, Leotta C, Liberman JN, Chee E, et al. Pharmacy and medical claims data identified migraine sufferers with high specificity but modest sensitivity. J Clin Epidemiol. 2004;57(9):962–72.
doi: 10.1016/j.jclinepi.2004.01.014 pubmed: 15504639
The Royal College of Emergency Medicine Best Practice Guideline. Management of pain in adults. London, England; 2021.
Woolner V, Ahluwalia R, Lum H, Beane K, Avelino J, Chartier LB. Improving timely analgesia administration for musculoskeletal pain in the emergency department. BMJ Open Quality. 2020;9(1).
Mehta V, Langford R. Acute pain management in opioid dependent patients. Rev Pain. 2009;3(2):10–4.
doi: 10.1177/204946370900300204 pubmed: 26525109 pmcid: 4590043
Health Quality Ontario. Opioid prescribing for acute pain: care for people 15 years of age and older. Toronto: Ontario; 2018.
Qaseem A, McLean RM, O’Gurek D, Batur P, Lin K, Kansagara DL, et al. Nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults: a clinical guideline from the American College of Physicians and American Academy of Family Physicians. Ann Intern Med. 2020;173(9):739–48.
doi: 10.7326/M19-3602 pubmed: 32805126
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. J Am Med Assoc. 2016;315(15):1624–45.
doi: 10.1001/jama.2016.1464
Tobias JD, Green TP, Coté CJ. Codeine: time to say "no". Pediatrics. 2016;138(4).
"Weak" opioid analgesics. Codeine, dihydrocodeine and tramadol: no less risky than morphine. Prescrire Int. 2016;25(168):45–50.
Government of Canada. Regulations amending the narcotic control regulations (tramadol): SOR/2021–43. In: Canada Gazette, editor. 2021.

Auteurs

Bill Sevcik (B)

Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Kevin Lobay (K)

Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Huong Luu (H)

Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Karen J B Martins (KJB)

Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Khanh Vu (K)

Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Phuong Uyen Nguyen (PU)

Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Solmaz Bohlouli (S)

Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Dean T Eurich (DT)

School of Public Health, University of Alberta, Edmonton, AB, Canada.

Erica L W Lester (ELW)

Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Tyler Williamson (T)

Department of Community Health Sciences, Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Lawrence Richer (L)

Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Scott W Klarenbach (SW)

Department of Medicine and Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. swk@ualberta.ca.

Classifications MeSH