Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA.
Acad Emerg Med. 2010 Mar;17(3):276-83. doi: 10.1111/j.1553-2712.2009.00676.x.
The authors assessed the association between measures of emergency department (ED) crowding and treatment with analgesia and delays to analgesia in ED patients with back pain.
This was a retrospective cohort study of nonpregnant patients who presented to two EDs (an academic ED and a community ED in the same health system) from July 1, 2003, to February 28, 2007, with a chief complaint of "back pain." Each patient had four validated crowding measures assigned at triage. Main outcomes were the use of analgesia and delays in time to receiving analgesia. Delays were defined as greater than 1 hour to receive any analgesia from the triage time and from the room placement time. The Cochrane-Armitage test for trend, the Cuzick test for trend, and relative risk (RR) regression were used to test the effects of crowding on outcomes.
A total of 5,616 patients with back pain presented to the two EDs over the study period (mean+/-SD age=44+/-17 years, 57% female, 62% black or African American). Of those, 4,425 (79%) received any analgesia while in the ED. A total of 3,589 (81%) experienced a delay greater than 1 hour from triage to analgesia, and 2,985 (67%) experienced a delay more than 1 hour from room placement to analgesia. When hospitals were analyzed separately, a higher proportion of patients experienced delays at the academic site compared with the community site for triage to analgesia (87% vs. 74%) and room to analgesia (71% vs. 63%; both p<0.001). All ED crowding measures were associated with a higher likelihood for delays in both outcomes. At the academic site, patients were more likely to receive analgesia at the highest waiting room numbers. There were no other differences in ED crowding and likelihood of receiving medications in the ED at the two sites. These associations persisted in the adjusted analysis after controlling for potential confounders of analgesia administration.
As ED crowding increases, there is a higher likelihood of delays in administration of pain medication in patients with back pain. Analgesia administration was not related to three measures of ED crowding; however, patients were actually more likely to receive analgesics when the waiting room was at peak levels in the academic ED.
作者评估了急诊科（ED）拥挤程度的测量指标与接受镇痛治疗以及腰痛 ED 患者接受镇痛治疗之间的延迟之间的关联。
这是一项回顾性队列研究，纳入了 2003 年 7 月 1 日至 2007 年 2 月 28 日期间在两家医院就诊的非妊娠患者，主要诊断为“腰痛”。每位患者在分诊时都有四个经过验证的拥挤程度指标。主要结局是使用镇痛药物和接受镇痛治疗的时间延迟。延迟定义为从分诊时间到接受任何镇痛药物的时间以及从安排房间到接受任何镇痛药物的时间超过 1 小时。采用 Cochrane-Armitage 趋势检验、Cuzick 趋势检验和相对风险（RR）回归来检验拥挤对结局的影响。
在研究期间，共有 5616 例腰痛患者到这两家 ED 就诊（平均年龄+/-标准差为 44+/-17 岁，57%为女性，62%为黑种人或非裔美国人）。其中，4425 例（79%）在 ED 期间接受了任何镇痛药物。共有 3589 例（81%）经历了从分诊到接受镇痛药物超过 1 小时的延迟，2985 例（67%）经历了从安排房间到接受镇痛药物超过 1 小时的延迟。分别分析医院时，与社区医院相比，学术医院的患者在分诊到接受镇痛药物（87%比 74%）和从安排房间到接受镇痛药物（71%比 63%）的延迟比例更高（均<0.001）。所有 ED 拥挤程度指标均与两种结局的延迟更大概率相关。在学术医院，随着候诊室人数的增加，患者更有可能接受镇痛药物治疗。在两个地点，ED 拥挤程度和接受 ED 药物治疗的可能性均无其他差异。在控制镇痛药物给药的潜在混杂因素后，这些关联在调整分析中仍然存在。
随着 ED 拥挤程度的增加，腰痛患者接受疼痛药物治疗的延迟更有可能增加。镇痛药物的给药与 ED 拥挤的三个测量指标无关；然而，在学术 ED 的候诊室达到高峰水平时，患者实际上更有可能接受镇痛药物治疗。
