A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures.
A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures.
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不同类型骨折急诊科疼痛护理的多中心评估。
DOI：
10.1093/pm/pnw072
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Hwang,Ula
中科院分区：
文献类型：
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作者：
Siddiqui,Ammar;Belland,Laura;Rivera-Reyes,Laura;Handel,Daniel;Yadav,Kabir;Heard,Kennon;Eisenberg,Amanda;Khelemsky,Yury;Hwang,Ula
目标。根据骨折类型确定急诊科(ED)疼痛护理的差异，并检查骨折类型是否会影响先前在老年患者中显示的更积极的止痛药的使用。回顾队列研究的二次分析。美国五名EDS(四名学者，一名社区)。参与者。2009年1月、3月、7月和10月确诊为骨折的患者(1,664例)(长骨774例，短骨890例)。测量。主要预测因素是骨折类型(LBF与SBF)。疼痛护理过程的结果包括给予止痛剂的可能性、阿片类药物的剂量和首次止痛药的时间。一般估计方程被用来控制年龄、性别、种族、基线疼痛评分、分诊敏锐度、合并症和ED拥挤。通过亚组分析，分析骨折类型在疼痛护理方面的年龄差异。与SBF(13%)相比，LBF患者(30%)年龄更大(65岁)。与SBF相比，LBF患者服用止痛药的可能性更大(OR = 2.03；95 CI=1.58~2.62；P<； 0.001)和阿片类药物剂量更高(参数估计 = 0.268；95 CI=0.239~0.297；P<； 0.001)。当分别检查腰腿痛时，老年患者有延长止痛等待时间的趋势(99[55-163]分钟比76[35-149]分钟，P= 0.057)，但没有发现其他过程结果的差异。与SBF相比，长骨骨折与更积极的疼痛护理相关。当单独检查骨折类型时，老年患者似乎没有接受更积极的疼痛护理。这种差异应该在进一步的研究中得到解释。
Objectives. To identify differences in emergency department (ED) pain-care based on the type of fracture sustained and to examine whether fracture type may influence the more aggressive analgesic use previously demonstrated in older patients.Design. Secondary analysis of retrospective cohort study.Setting. Five EDs (four academic, one community) in the United States.Participants. Patients (1,664) who presented in January, March, July, and October 2009 with a final diagnosis of fracture (774 long bone [LBF], 890 shorter bone [SBF]).Measurements. Primary-predictor was type of fracture (LBF vs. SBF). Pain-care process outcomes included likelihood of analgesic administration, opioid-dose, and time to first analgesic. General estimating equations were used to control for age, gender, race, baseline pain score, triage acuity, comorbidities and ED crowding. Subgroup analyses were conducted to analyze age-based differences in pain care by fracture type.Results. A larger proportion of patients with LBF (30%) were older (>65 years old) compared to SBF (13%). Compared with SBF, patients with LBF were associated with greater likelihood of analgesic-administration (OR = 2.03; 95 CI = 1.58 to 2.62;P< 0.001) and higher opioid-doses (parameter estimate = 0.268; 95 CI = 0.239 to 0.297;P< 0.001). When LBF were examined separately, older-patients had a trend to longer analgesic wait-times (99 [55–163] vs. 76 [35–149] minutes,P= 0.057), but no other differences in process outcomes were found.Conclusion. Long bone fractures were associated with more aggressive pain care than SBF. When fracture types were examined separately, older patients did not appear to receive more aggressive pain care. This difference should be accounted for in further research.