Opioid Prescribing in a Cross Section of US Emergency Departments
Opioid Prescribing in a Cross Section of US Emergency Departments
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DOI：
10.1016/j.annemergmed.2015.03.026
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发表时间：
2015-09-01
影响因子：
6.2
通讯作者：
Weiner, Scott G.
中科院分区：
文献类型：
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作者：
Hoppe, Jason A.;Nelson, Lewis S.;Weiner, Scott G.
研究目的：在过去十年中，急诊科（艾德）出院时阿片类止痛药处方有所增加，但缺乏具体的处方细节。以前的艾德阿片类止痛药处方估计依赖于国家调查外推或处方数据库。本研究的主要目标是利用一个研究联盟，使用全国艾德患者样本来分析患者和阿片类药物处方的特征。我们还旨在研究阿片类止痛药处方的适应症，阿片类药物的特点，规定在艾德和出院时，和特点的患者谁收到阿片类止痛药相比，那些谁没有.Methods：这项观察性，多中心，回顾性，队列研究评估阿片类止痛药处方连续患者在2012年10月1周的联盟ED。联盟研究中心由19个ED组成，代表140万次年度访问，地理位置不同，主要是学术中心。研究者通过标准化图表审查对所有年龄在18至90岁之间且出院时使用阿片类止痛药（不包括曲马多）的患者的病历进行单独提取，以进行详细分析。结果：在研究周期间，在联盟ED中评估了27，516例患者访视; 19，321例患者（70.2%）出院，3，284例（所有患者的11.9%和出院患者的17.0%）接受阿片类止痛药处方。对于处方阿片类止痛药的患者，平均年龄为41岁（SD 14岁），1，694例（51.6%）为女性。平均初始疼痛评分为7.7（SD 2.4）。与阿片类止痛药处方相关的最常见诊断为背痛（10.2%）、腹痛（10.1%）和四肢骨折（7.1%）或扭伤（6.5%）。处方的最常见阿片类止痛药为羟考酮（52.3%）、氢可酮（40.9%）和可待因（4.8%）。大于99%的止痛药立即释放和90.0%的组合制剂，药丸的平均数和中位数分别为16.6（SD 7.6）和15（四分位数间距12至20），respectively：在一项研究中，艾德患者在全国范围内的一个星期内治疗，17%的出院患者处方阿片类止痛药。大多数处方的药丸数量很少，几乎完全是速释制剂。
Study objective: Opioid pain reliever prescribing at emergency department (ED) discharge has increased in the past decade but specific prescription details are lacking. Previous ED opioid pain reliever prescribing estimates relied on national survey extrapolation or prescription databases. The main goal of this study is to use a research consortium to analyze the characteristics of patients and opioid prescriptions, using a national sample of ED patients. We also aim to examine the indications for opioid pain reliever prescribing, characteristics of opioids prescribed both in the ED and at discharge, and characteristics of patients who received opioid pain relievers compared with those who did not.Methods: This observational, multicenter, retrospective, cohort study assessed opioid pain reliever prescribing to consecutive patients presenting to the consortium EDs during 1 week in October 2012. The consortium study sites consisted of 19 EDs representing 1.4 million annual visits, varied geographically, and were predominantly academic centers. Medical records of all patients aged 18 to 90 years and discharged with an opioid pain reliever (excluding tramadol) were individually abstracted by standardized chart review by investigators for detailed analysis. Descriptive statistics were generated.Results: During the study week, 27,516 patient visits were evaluated in the consortium EDs; 19,321 patients (70.2%) were discharged and 3,284 (11.9% of all patients and 17.0% of discharged patients) received an opioid pain reliever prescription. For patients prescribed an opioid pain reliever, mean age was 41 years (SD 14 years) and 1,694 (51.6%) were women. Mean initial pain score was 7.7 (SD 2.4). The most common diagnoses associated with opioid pain reliever prescribing were back pain (10.2%), abdominal pain (10.1%), and extremity fracture (7.1%) or sprain (6.5%). The most common opioid pain relievers prescribed were oxycodone (52.3%), hydrocodone (40.9%), and codeine (4.8%). Greater than 99% of pain relievers were immediate release and 90.0% were combination preparations, and the mean and median number of pills was 16.6 (SD 7.6) and 15 (interquartile range 12 to 20), respectively.Conclusion: In a study of ED patients treated during a single week across the country, 17% of discharged patients were prescribed opioid pain relievers. The majority of the prescriptions had small pill counts and almost exclusively immediate-release formulations.