Quattromani Erin, Normansell Daniel, Storkan Michelle, Gerdelman Grant, Krits Semeon, Pennix Charles, Sprowls David, Armbrecht Eric, Dalawari Preeti
Saint Louis University School of Medicine, Saint Louis, Missouri.
J Emerg Med. 2015 Jun;48(6):653-9. doi: 10.1016/j.jemermed.2014.12.043. Epub 2015 Mar 18.
Research suggests that older age can influence perception, assessment, and treatment of acute pain, resulting in inadequate pain control for geriatric patients.
The purpose of this study was to determine if geriatric trauma patients are less likely to receive analgesia in our emergency department (ED).
This retrospective chart review includes blunt trauma adult patients who presented to a Level I trauma center ED between June 1 and December 31, 2012. Age was categorized as ≥65 years old and 18-64 years old. χ(2) was used to analyze differences in patients receiving pain medication by age groups. Analysis excluded those with no or low pain. A logistic regression model estimated the odds ratio of analgesic use controlling for age, pain level, sex, race, alcohol, drugs, Glasgow Coma Scale, ED length of stay, and Injury Severity Score. T-test compared differences in analgesia administration time.
Four hundred and sixty-three blunt trauma patients were included in the analysis. Seventy percent of those ≥65 years received analgesia, compared with 84% of those 18-64 years old (p < 0.01). The mean time to analgesia administration was 92 min (≥65 years) compared to 61 min (18-64 years) (p = 0.03). Those ≥65 years were 69% less likely (odds ratio = 0.31; 95% confidence interval 0.16-0.59) to receive analgesia compared to patients aged 18-64 years, after controlling for confounders.
Trauma patients ≥ 65 years of age are less likely to receive analgesia than the younger cohort in our ED and waited longer to get it.
研究表明，年龄较大可能会影响急性疼痛的感知、评估和治疗，导致老年患者的疼痛控制不足。
本研究的目的是确定老年创伤患者在我们急诊科接受镇痛治疗的可能性是否较低。
这项回顾性病历审查纳入了2012年6月1日至12月31日期间在一级创伤中心急诊科就诊的钝性创伤成年患者。年龄分为≥65岁和18 - 64岁。采用χ(2)分析不同年龄组患者接受止痛药物治疗的差异。分析排除了无疼痛或疼痛程度低的患者。逻辑回归模型估计了在控制年龄、疼痛程度、性别、种族、酒精、药物、格拉斯哥昏迷量表、急诊科停留时间和损伤严重程度评分后使用镇痛药的比值比。t检验比较了镇痛给药时间的差异。
463例钝性创伤患者纳入分析。≥65岁的患者中有70%接受了镇痛治疗，而18 - 64岁的患者中这一比例为84%（p < 0.01）。镇痛给药的平均时间为92分钟（≥65岁），而18 - 64岁为61分钟（p = 0.03）。在控制混杂因素后，≥65岁的患者接受镇痛治疗的可能性比18 - 64岁的患者低69%（比值比 = 0.31；95%置信区间0.16 - 0.59）。
在我们的急诊科，≥65岁的创伤患者比年轻患者接受镇痛治疗的可能性更低，且等待时间更长。
