Older US Emergency Department Patients Are Less Likely to Receive Pain Medication Than Younger Patients: Results From a National Survey
Older US Emergency Department Patients Are Less Likely to Receive Pain Medication Than Younger Patients: Results From a National Survey
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DOI：
10.1016/j.annemergmed.2011.09.014
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发表时间：
2012-08-01
影响因子：
6.2
通讯作者：
McLean, Samuel A.
中科院分区：
文献类型：
--
作者：
Platts-Mills, Timothy F.;Esserman, Denise A.;McLean, Samuel A.
研究目的：本研究的目的是确定是否老年人提出的急诊科（艾德）疼痛是不太可能接受止痛药比年轻adults.Methods：疼痛相关的访问美国ED确定与访问的原因代码从7年（2003年至2009年）的全国医院门诊医疗服务调查。主要结局是给予镇痛剂。在4个年龄组接受镇痛药的患者的百分比进行了调整测量协变量，包括疼痛severity.Results：疼痛相关的访问占88,031（46.9%）艾德访问的患者年龄在18岁或以上的7年期间。年龄≥ 75岁的患者有7，585次疼痛相关艾德就诊，相当于每年约365万次美国艾德就诊。在比较调查加权未校正估计值时，75岁或以上患者的疼痛相关访视导致给予镇痛剂（49% vs 68.3%）或阿片类药物（34.8% vs 49.3%）的可能性低于35 - 54岁患者。在调整性别、人种/种族、疼痛严重程度和其他因素以及缺失疼痛严重程度数据的多重插补后，镇痛剂和阿片类药物给药率的绝对差异持续存在，75岁及以上患者就诊率为19.6%（95%置信区间17.8%-21.4%）年龄35 - 54岁患者接受镇痛剂的可能性低于访视，14.6%（95%可信区间12.8%~ 16.4%）不太可能接受阿片类药物治疗。结论：75岁及以上疼痛相关艾德就诊的患者比35 ~ 54岁的患者接受止痛药治疗的可能性更小。[Ann 2012;60：199-206]
Study objective: The purpose of this study is to determine whether older adults presenting to the emergency department (ED) with pain are less likely to receive pain medication than younger adults.Methods: Pain-related visits to US EDs were identified with reason-for-visit codes from 7 years (2003 to 2009) of the National Hospital Ambulatory Medical Care Survey. The primary outcome was the administration of an analgesic. The percentage of patients receiving analgesics in 4 age groups was adjusted for measured covariates, including pain severity.Results: Pain-related visits accounted for 88,031 (46.9%) ED visits by patients aged 18 years or older during the 7-year period. There were 7,585 pain-related ED visits by patients aged 75 years or older, representing an estimated 3.65 million US ED visits annually. In comparing survey-weighted unadjusted estimates, pain-related visits by patients aged 75 years or older were less likely than visits by patients aged 35 to 54 years to result in administration of an analgesic (49% versus 68.3%) or an opioid (34.8% versus 49.3%). Absolute differences in rates of analgesic and opioid administration persisted after adjustment for sex, race/ethnicity, pain severity, and other factors and multiple imputation of missing pain severity data, with visits by patients aged 75 years and older being 19.6% (95% confidence interval 17.8% to 21.4%) less likely than visits by patients aged 35 to 54 years to receive an analgesic and 14.6% (95% confidence interval 12.8% to 16.4%) less likely to receive an opioid.Conclusion: Patients aged 75 years and older with pain-related ED visits are less likely to receive pain medication than patients aged 35 to 54 years. [Ann Emerg Med. 2012;60:199-206]