Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit.
Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit.
复制标题
DOI：
10.1016/j.ajem.2017.07.037
复制
发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Wilkie DJ
中科院分区：
文献类型：
--
作者：
Molokie RE;Montminy C;Dionisio C;Farooqui MA;Gowhari M;Yao Y;Suarez ML;Ezenwa MO;Schlaeger JM;Wang ZJ;Wilkie DJ
与急诊科（艾德）相比，具有集中镰状细胞病（SCD）护理的急性监护病房（ACU）已被证明可以有效地解决疼痛并限制住院，入院率差异的原因尚未得到充分研究。我们的目的是比较ACU和艾德中成人SCD疼痛的常规护理对阿片类药物剂量和出院疼痛评分、住院率和住院时间的影响。在一项回顾性、比较队列、单学术三级中心研究中，148名镰状细胞疼痛成人在艾德、ACU或两者接受治疗。从医疗记录中，我们记录了阿片类药物剂量，单位出院疼痛评级，住院率和住院时间。艾德入院时疼痛平均为8.7 ± 1.5，ACU平均为8.0 ± 1.6。从艾德出院时的平均疼痛为6.4 ± 3.0，ACU为4.5 ± 2.5。144次艾德访视中有70%导致住院，而73次ACU访视中有37%导致住院。从艾德或ACU入院的患者住院时间相似。注意到艾德和ACU在首次阿片类药物剂量和每小时阿片类药物剂量方面存在显著差异。与ED相比，ACU中SCD成人急性疼痛发作应用更高剂量阿片类药物的指南与疼痛结局改善和住院率降低相关。在艾德中采用这种方法治疗SCD疼痛可能会改善结局，包括住院率降低。
Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay. In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay. Pain on admission to the ED averaged 8.7 ± 1.5 and to the ACU averaged 8.0 ± 1.6. The average pain on discharge from the ED was 6.4 ± 3.0 and for the ACU was 4.5 ± 2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted. Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions.
登录
查看更多内容
影响因子：
6.5
作者：
Ware, MA;Hambleton, I;Serjeant, GR
通讯作者：
Serjeant, GR
影响因子：
6.2
作者：
Gilbert, EH;Lowenstein, SR;Steiner, J
通讯作者：
Steiner, J
影响因子：
20.3
作者：
Ballas, Samir K.;Gupta, Kalpna;Adams-Graves, Patricia
通讯作者：
Adams-Graves, Patricia
影响因子：
3.3
作者：
Solomon, Lawrence R.
通讯作者：
Solomon, Lawrence R.
影响因子：
4.7
作者：
TESLER, MD;WILKIE, D;SAVEDRA, MC
通讯作者：
SAVEDRA, MC