Neighbor Martha L, Baird Carina H, Kohn Michael A
University of California, San Francisco, Lafayette, CA, USA.
Acad Emerg Med. 2005 Dec;12(12):1216-20. doi: 10.1197/j.aem.2005.07.024. Epub 2005 Nov 17.
To compare the use of opioid analgesia in the treatment of emergency department patients with acute right lower quadrant (RLQ) abdominal pain between 1998 and 2003 and to explore the relationship between opioid use and abdominal computed tomography (CT) scanning.
This was a retrospective cohort study of patients presenting in 1998 and 2003 to an urban emergency department with a triage complaint of RLQ pain. The authors abstracted use and timing of abdominal CT scanning and opioid analgesia. Other predictor variables were patient demographics. Risk ratio for receiving opioids with CT scan versus without CT scan, stratifying by year, were calculated. Proportional-hazards analysis was used to control for time in the emergency department.
Of the 187 patients seen in 1998, 38 (20%) underwent CT scanning and 43 (23%) received opioids. Of the 137 patients seen in 2003, 77 (56%) underwent CT scanning and 72 (53%) received opioids. In 1998, the risk ratio for receiving opioids in patients who underwent CT scanning (vs. without) was 3.7 (95% confidence interval [CI] = 2.3 to 6.1); in 2003, it was 1.5 (95% CI = 1.0 to 2.1). Opioids were overwhelmingly given before CT scanning in those patients who received both (81% in 1998 and 98% in 2003). The mean time to administration of the first opioid dose in 1998 was 155 minutes and in 2003 was 94 minutes. The proportional-hazards analysis confirmed a strong association between CT scanning and opioid administration in 1998 (relative hazard, 2.7; 95% CI = 1.5 to 5.1) and substantial attenuation of the association in 2003 (relative hazard, 1.3; 95% CI = 0.8 to 2.1). The hospitalization rate was not significantly different in 2003 (33%) versus 1998 (27%) (p = 0.28). The risk ratio of receiving opioids in admitted patients was 2.8 (95% CI = 1.7 to 4.6) in 1998 and 2.0 (95% CI = 1.5 to 2.7) in 2003.
Opioid administration to patients with RLQ pain has dramatically increased between 1998 and 2003. During these five years, the number of patients receiving opioids more than doubled and the time to first administration of opioids decreased by one hour. The authors show that this cannot be attributed to an increased use of CT scanning.
比较1998年至2003年间急诊科急性右下腹（RLQ）腹痛患者使用阿片类镇痛药的情况，并探讨阿片类药物使用与腹部计算机断层扫描（CT）之间的关系。
这是一项回顾性队列研究，研究对象为1998年和2003年因分诊主诉为RLQ疼痛而到城市急诊科就诊的患者。作者提取了腹部CT扫描和阿片类镇痛药的使用情况及时间。其他预测变量为患者人口统计学特征。计算按年份分层的接受CT扫描与未接受CT扫描患者使用阿片类药物的风险比。采用比例风险分析来控制在急诊科的停留时间。
1998年就诊的187例患者中，38例（20%）接受了CT扫描，43例（23%）使用了阿片类药物。2003年就诊的137例患者中，77例（56%）接受了CT扫描，72例（53%）使用了阿片类药物。1998年，接受CT扫描的患者使用阿片类药物的风险比（与未接受CT扫描的患者相比）为3.7（95%置信区间[CI]=2.3至6.1）；2003年为1.5（95%CI=1.0至2.1）。在同时接受两者治疗的患者中，绝大多数（1998年为81%，2003年为98%）在CT扫描前就给予了阿片类药物。1998年首次给予阿片类药物剂量的平均时间为155分钟，2003年为94分钟。比例风险分析证实，1998年CT扫描与阿片类药物给药之间存在强关联（相对风险，2.7；95%CI=1.5至5.1），而2003年这种关联大幅减弱（相对风险，1.3；95%CI=0.8至2.1）。2003年的住院率（33%）与1998年（27%）相比无显著差异（p=0.28）。1998年入院患者使用阿片类药物的风险比为2.8（95%CI=1.7至4.6），2003年为2.0（95%CI=1.5至2.7）。
1998年至2003年间，RLQ疼痛患者使用阿片类药物的情况显著增加。在这五年中，接受阿片类药物治疗的患者数量增加了一倍多，首次使用阿片类药物的时间减少了一小时。作者表明，这不能归因于CT扫描使用的增加。
