Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States; Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
J Pain Symptom Manage. 2017 Oct;54(4):501-507. doi: 10.1016/j.jpainsymman.2017.07.013. Epub 2017 Jul 17.
There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during emergency department (ED) encounters.
To determine if opioid-tolerant cancer patients presenting with acute pain exacerbations receive adequate initial doses of as needed (PRN) opioids during ED encounters based on home oral morphine equivalent (OME) use.
We performed a retrospective cohort study of opioid-tolerant cancer patients who received opioids in our ED over a two-year period. The percentage of patients who received an adequate initial dose of PRN opioid (defined as ≥10% of total 24-hour ambulatory OME) was evaluated. Logistic regression was used to establish the relationship between 24-hour ambulatory OME and initial ED OME to assess whether higher home usage was associated with higher likelihood of being undertreated.
Out of 216 patients, 61.1% of patients received an adequate initial PRN dose of opioids in the ED. Of patients taking <200 OMEs per day at home, 77.4% received an adequate initial dose; however, only 3.2% of patients taking >400 OMEs per day at home received an adequate dose. Patients with ambulatory 24-hour OME greater than 400 had 99% lower odds of receiving an adequate initial dose of PRN opioid in the ED compared to patients with ambulatory 24-hour OME less than 100 (OR <0.01, CI 0.00-0.02, P < 0.001).
Patients with daily home use less than 200 OMEs generally received adequate initial PRN opioid doses during their ED visit. However, patients with higher home opioid usage were at increased likelihood of being undertreated.
目前尚无研究调查在急诊科（ED）就诊的阿片类药物耐受的癌症患者所接受的阿片类药物剂量。
根据家庭口服吗啡等效剂量（OME）的使用情况，确定在 ED 就诊时，是否有急性疼痛加重的阿片类药物耐受的癌症患者接受了足够的按需（PRN）阿片类药物初始剂量。
我们对在两年内我们的 ED 接受阿片类药物治疗的阿片类药物耐受的癌症患者进行了回顾性队列研究。评估了接受足够 PRN 阿片类药物初始剂量（定义为≥总 24 小时门诊 OME 的 10%）的患者比例。使用逻辑回归建立了 24 小时门诊 OME 与初始 ED OME 之间的关系，以评估家庭使用量较高是否与治疗不足的可能性增加相关。
在 216 名患者中，61.1%的患者在 ED 接受了足够的初始 PRN 阿片类药物剂量。在家中每天服用 OME 少于 200 的患者中，有 77.4%接受了足够的初始剂量；然而，在家中每天服用 OME 超过 400 的患者中，只有 3.2%接受了足够的剂量。与每天服用 OME 少于 100 的患者相比，每天服用 OME 超过 400 的患者在 ED 接受足够初始 PRN 阿片类药物剂量的可能性低 99%（OR <0.01，CI 0.00-0.02，P <0.001）。
在家中每天使用 OME 少于 200 的患者通常在 ED 就诊时接受了足够的初始 PRN 阿片类药物剂量。然而，家庭中阿片类药物用量较高的患者治疗不足的可能性增加。
