Young Neil, Silverman Daniel, Bradford Heather, Finkelstein Jeffrey
UCONN Integrated Residency in Emergency Medicine, Hartford, CT, United States.
UCONN Integrated Residency in Emergency Medicine, Hartford, CT, United States.
Am J Emerg Med. 2017 Dec;35(12):1845-1849. doi: 10.1016/j.ajem.2017.06.015. Epub 2017 Jun 16.
Despite a range of therapeutic options for treating acute migraine headaches, the use of opioids is still reported to be common practice. This study describes treatment practices in regards to migraines in the ED. It characterizes the prevalence of opioid orders during visits in three different settings, an academic medical center, a non-academic urban ED, and a community ED. Fourteen months of consecutive migraine visits were identified. All medications ordered were separated into first-line and rescue medications. Number of visits, length of stay, door to provider time, and total provider time were compared. A total of 1222 visits were identified. Opioids were ordered in 35.8% of these visits. By facility, opioids were ordered in 12.3% of academic medical center visits, 40.9% of urban ED visits, and 68.6% of community ED visits. This ranged from 6.9% of first-line therapies in the academic center to 69.9% of rescue therapies in the community ED. Of those who received opioids, 36.0% versus 25.1% required rescue medications. Patients who received opioids had more repeat visits, 1.79 versus 1.30. The academic center and urban ED both found greater than 30% decrease in length of stay in visits where opioids were not given. In the face of evidence against opioids for migraines, over one third of patients received them. There was a higher prevalence in the community setting. There were no significant benefits in overall throughput time, however, opioid visits required more rescue medications, increased length of stay, and resulted in more repeat visits.
尽管有一系列治疗急性偏头痛的方法，但据报道，使用阿片类药物仍是常见的做法。本研究描述了急诊科偏头痛的治疗情况。它对在三种不同环境（学术医疗中心、非学术城市急诊科和社区急诊科）就诊期间开具阿片类药物医嘱的情况进行了描述。确定了连续14个月的偏头痛就诊病例。所有开具的药物被分为一线药物和急救药物。比较了就诊次数、住院时间、从就诊到见到医生的时间以及医生诊疗总时间。共确定了1222次就诊。其中35.8%的就诊开具了阿片类药物。按医疗机构划分，学术医疗中心就诊中12.3%开具了阿片类药物，城市急诊科就诊中40.9%开具了阿片类药物，社区急诊科就诊中68.6%开具了阿片类药物。这一比例在学术中心一线治疗药物中为6.9%，在社区急诊科急救治疗药物中为69.9%。在接受阿片类药物治疗的患者中，36.0%与25.1%的患者需要急救药物。接受阿片类药物治疗的患者复诊次数更多，分别为1.79次和1.30次。学术医疗中心和城市急诊科均发现，未开具阿片类药物的就诊患者住院时间缩短超过30%。尽管有证据表明阿片类药物不适用于偏头痛治疗，但仍有超过三分之一的患者接受了此类药物。在社区环境中，其使用率更高。在整体就诊时间方面没有显著益处，然而，使用阿片类药物的就诊患者需要更多急救药物，住院时间增加，且复诊次数更多。
