Health Management Analytics, CVS|Caremark Inc., Northbrook, Illinois 60062, USA.
J Pain Symptom Manage. 2011 Feb;41(2):367-73. doi: 10.1016/j.jpainsymman.2010.04.023. Epub 2010 Oct 20.
Inappropriate pain documentation is likely to be an important contributor to the poor management of pain in elderly patients in the emergency department (ED). Failure to assess pain limits ability to treat pain.
The objectives of this study were to examine the relationship between visit characteristics of elderly patients and pain score documentation in the ED, and to determine predictors of analgesic use in the ED.
This was a cross-sectional analysis of documented ED visits by elderly patients from the National Hospital Ambulatory Medical Care Survey (2003-2006). The study included 5661 ED visits by patients aged 65 years and older, representing an estimated 18 million ED visits during the four-year study period. Univariate logistic regression was used to analyze associations among independent variables and documentation of pain. Multivariate logistic regression was used to determine whether nonopioid and opioid analgesic prescribing disparities existed and were associated with pain level.
Pain score documentation was found to be suboptimal in the elderly population in this study, with only 75% of visits having documented pain scores. Older age, self-pay, patients residing in the Western region of the United States, and emergent ED visits were associated with decreased pain score documentation. Documentation of pain score was associated with increased odds of an analgesic prescription and opioid analgesic prescription. Odds of prescribing an opioid increased significantly with increasing level of pain severity.
ED pain score documentation is suboptimal in the elderly population. Disparity in the use of analgesic prescriptions and opioid analgesics exists and may result in patients not receiving analgesics. Improving pain assessment and documentation, changes in attitude toward analgesic prescribing, and recognition of ethnic, racial, and age differences in patients with pain have the potential to contribute to effective management of pain in the ED.
在急诊科（ED），不恰当的疼痛记录可能是导致老年患者疼痛管理不善的一个重要因素。未能评估疼痛会限制疼痛治疗的能力。
本研究旨在探讨老年患者就诊特征与 ED 疼痛评分记录之间的关系，并确定 ED 中使用镇痛药的预测因素。
这是对国家医院门诊医疗调查（2003-2006 年）中记录的老年患者 ED 就诊情况的横断面分析。该研究包括 5661 名年龄在 65 岁及以上的患者的 ED 就诊，代表了四年研究期间估计 1800 万次 ED 就诊。采用单变量逻辑回归分析独立变量与疼痛记录之间的关联。采用多变量逻辑回归确定非阿片类和阿片类镇痛药的开具是否存在差异，并与疼痛程度相关。
本研究发现，老年人群的疼痛评分记录并不理想，只有 75%的就诊记录有疼痛评分。年龄较大、自费、居住在美国西部地区的患者和紧急 ED 就诊与疼痛评分记录减少有关。疼痛评分记录与开具镇痛药和阿片类镇痛药的可能性增加有关。随着疼痛严重程度的增加，开具阿片类药物的可能性显著增加。
ED 老年人群的疼痛评分记录并不理想。在使用镇痛药和阿片类药物方面存在差异，可能导致患者未接受镇痛药治疗。改善疼痛评估和记录、改变对镇痛药开具的态度以及认识到疼痛患者在种族、民族和年龄方面的差异，有可能有助于 ED 中疼痛的有效管理。
