*Department of Medicine,Division of Emergency Medicine,University of Toronto,Toronto,ON.
†Sunnybrook Health Sciences Centre,University of TorontoFaculty of Medicine,Toronto,ON.
CJEM. 2018 Jan;20(1):28-35. doi: 10.1017/cem.2017.37. Epub 2017 Jun 20.
Vertigo is common in the emergency department (ED). Most aetiologies are peripheral and do not require hospitalization, but many patients still fear falling. Some patients may be taking opioid analgesic medications (for other reasons); the risk of falls leading to fractures among patients with vertigo could be potentiated by the simultaneous use of opioids.
To examine the risk of fractures in discharged ED patients with peripheral vertigo who were being prescribed opioids during the same time period.
Linked administrative databases from Ontario were used to compare discharged ED patients aged ≥65 with peripheral vertigo to patients with urinary tract infection (UTI) from 2006 to 2011. We used Cox regression analysis with an interaction term to estimate the modifying effect of an opioid prescription on the hazard of fracture within 90 days.
There were 13,012 patients with a peripheral vertigo syndrome and 76,885 with a UTI. Thirteen percent of the vertigo cohort and 25% of the UTI cohort had access to a filled opioid prescription. Compared to vertigo patients who did not fill an opioid prescription, the adjusted hazard of fracture among vertigo patients who did fill a prescription was 3.59 (95% CI 1.97-6.13). Among UTI patients who filled an opioid prescription the hazard ratio was 1.68 (95% CI 1.43-1.97) compared to UTI patients who did not.
Patients discharged from the ED with peripheral vertigo who were also being prescribed opioids had a higher hazard of subsequent fracture compared to those who were not, and the effect was much greater than among UTI patients. These results suggest that in the acutely vertiginous older patient, opioid analgesic medications should be modified, where possible.
眩晕在急诊科（ED）很常见。大多数病因是周围性的，不需要住院治疗，但许多患者仍担心跌倒。一些患者可能因其他原因正在服用阿片类镇痛药物；同时使用阿片类药物可能会增加眩晕患者跌倒导致骨折的风险。
研究同时开具阿片类药物的外周性眩晕急诊科出院患者发生骨折的风险。
使用安大略省的链接行政数据库，将 2006 年至 2011 年期间患有外周性眩晕的年龄≥65 岁的出院 ED 患者与患有尿路感染（UTI）的患者进行比较。我们使用 Cox 回归分析和交互项来估计阿片类药物处方对 90 天内骨折发生风险的修饰作用。
共有 13012 例外周性眩晕综合征患者和 76885 例 UTI 患者。眩晕队列的 13%和 UTI 队列的 25%有机会获得阿片类药物处方。与未开阿片类药物处方的眩晕患者相比，开阿片类药物处方的眩晕患者骨折的调整后危险比为 3.59（95%CI 1.97-6.13）。与未开阿片类药物处方的 UTI 患者相比，开阿片类药物处方的 UTI 患者的危险比为 1.68（95%CI 1.43-1.97）。
从 ED 出院的患有外周性眩晕且同时被开阿片类药物处方的患者与未开阿片类药物处方的患者相比，随后发生骨折的危险更高，其效果远大于 UTI 患者。这些结果表明，在急性眩晕的老年患者中，应尽可能调整阿片类镇痛药物。
