The Effect of Emergency Department Crowding on Analgesia in Patients with Back Pain in Two Hospitals
The Effect of Emergency Department Crowding on Analgesia in Patients with Back Pain in Two Hospitals
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DOI：
10.1111/j.1553-2712.2009.00676.x
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发表时间：
2010-03-01
影响因子：
4.4
通讯作者：
Mills, Angela M.
中科院分区：
文献类型：
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作者：
Pines, Jesse M.;Shofer, Frances S.;Mills, Angela M.
目的：作者评估急诊科（ED）拥挤程度与ED背痛患者镇痛治疗和延迟镇痛治疗之间的关系。方法：这是一项回顾性队列研究，研究对象为2003年7月1日至2007年2月28日期间以“背部疼痛”为主诉就诊于两家急诊科（同一医疗系统的一所学术急诊科和一所社区急诊科）的非怀孕患者。每个病人在分诊时都有四种有效的拥挤措施。主要结局是镇痛的使用和延迟接受镇痛的时间。延迟被定义为从分诊时间和房间放置时间到接受任何镇痛超过1小时。使用Cochrane-Armitage趋势检验、Cuzick趋势检验和相对风险（RR）回归来检验拥挤对结果的影响。结果：在研究期间，共有5616名背痛患者出现在两个急诊科（平均+/- SD年龄= 44 +/- 17岁，57%为女性，62%为黑人或非裔美国人）。其中，4425人（79%）在急诊科接受了任何镇痛治疗。共有3589人（81%）从分诊到镇痛的延迟超过1小时，2985人（67%）从房间放置到镇痛的延迟超过1小时。当分别对医院进行分析时，与社区站点相比，在学术站点进行镇痛分诊的患者比例更高（87%对74%），在病房进行镇痛分诊的患者比例更高（71%对63%，p均< 0.001）。所有的急诊科拥挤措施都与两种结果延迟的可能性较高有关。在学术场所，患者更有可能在等候室人数最多的时候接受镇痛。在两个地点的急诊科拥挤程度和接受药物治疗的可能性方面没有其他差异。在控制了镇痛给药的潜在混杂因素后，这些关联在调整后的分析中仍然存在。结论：随着急诊科拥挤程度的增加，背痛患者延迟给药的可能性更高。镇痛给药与ED拥挤的三项指标无关；然而，在学术ed中，当候诊室达到高峰时，患者实际上更有可能接受镇痛药；17:27 -283 (C) 2010由学术急诊医学学会。
Objectives:The authors assessed the association between measures of emergency department (ED) crowding and treatment with analgesia and delays to analgesia in ED patients with back pain.Methods:This was a retrospective cohort study of nonpregnant patients who presented to two EDs (an academic ED and a community ED in the same health system) from July 1, 2003, to February 28, 2007, with a chief complaint of "back pain." Each patient had four validated crowding measures assigned at triage. Main outcomes were the use of analgesia and delays in time to receiving analgesia. Delays were defined as greater than 1 hour to receive any analgesia from the triage time and from the room placement time. The Cochrane-Armitage test for trend, the Cuzick test for trend, and relative risk (RR) regression were used to test the effects of crowding on outcomes.Results:A total of 5,616 patients with back pain presented to the two EDs over the study period (mean +/- SD age = 44 +/- 17 years, 57% female, 62% black or African American). Of those, 4,425 (79%) received any analgesia while in the ED. A total of 3,589 (81%) experienced a delay greater than 1 hour from triage to analgesia, and 2,985 (67%) experienced a delay more than 1 hour from room placement to analgesia. When hospitals were analyzed separately, a higher proportion of patients experienced delays at the academic site compared with the community site for triage to analgesia (87% vs. 74%) and room to analgesia (71% vs. 63%; both p < 0.001). All ED crowding measures were associated with a higher likelihood for delays in both outcomes. At the academic site, patients were more likely to receive analgesia at the highest waiting room numbers. There were no other differences in ED crowding and likelihood of receiving medications in the ED at the two sites. These associations persisted in the adjusted analysis after controlling for potential confounders of analgesia administration.Conclusions:As ED crowding increases, there is a higher likelihood of delays in administration of pain medication in patients with back pain. Analgesia administration was not related to three measures of ED crowding; however, patients were actually more likely to receive analgesics when the waiting room was at peak levels in the academic ED.ACADEMIC EMERGENCY MEDICINE 2010; 17:276-283 (C) 2010 by the Society for Academic Emergency Medicine.