Department of Emergency Medicine, University of Ottawa, Ottawa, ON.
Faculty of Medicine, University of Ottawa, Ottawa, ON.
CJEM. 2020 Jul;22(4):486-493. doi: 10.1017/cem.2020.50.
Opioid related mortality rate has increased 200% over the past decade. Studies show variable emergency department (ED) opioid prescription practices and a correlation with increased long-term use. ED physicians may be contributing to this problem. Our objective was to analyze ED opioid prescription practices for patients with acute fractures.
We conducted a review of ED patients seen at two campuses of a tertiary care hospital. We evaluated a consecutive sample of patients with acute fractures (January 2016-April 2016) seen by ED physicians. Patients admitted or discharged by consultant services were excluded. The primary outcome was the proportion of patients discharged with an opioid prescription. Data were collected using screening lists, electronic records, and interobserver agreement. We calculated simple descriptive statistics and a multivariable analysis.
We enrolled 816 patients, including 441 females (54.0%). Most common fracture was wrist/hand (35.2%). 260 patients (31.8%) were discharged with an opioid; hydromorphone (N = 115, range 1-120 mg) was most common. 35 patients (4.3%) had pain related ED visits <1 month after discharge. Fractures of the lumbar spine (OR 10.78 [95% CI: 3.15-36.90]) and rib(s)/sternum/thoracic spine (OR 5.46 [95% CI: 2.88-10.35)] had a significantly higher likelihood of opioid prescriptions.
The majority of patients presenting to the ED with acute fractures were not discharged with an opioid. Hydromorphone was the most common opioid prescribed, with large variations in total dosage. Overall, there were few return to ED visits. We recommend standardization of ED opioid prescribing, with attention to limiting total dosage.
在过去的十年中，阿片类药物相关死亡率增加了 200%。研究表明，急诊科（ED）的阿片类药物处方实践存在差异，且与长期使用增加相关。ED 医生可能对此问题负有责任。我们的目的是分析 ED 中急性骨折患者的阿片类药物处方实践。
我们对一家三级保健医院的两个校区的 ED 患者进行了回顾性研究。我们评估了由 ED 医生诊治的连续急性骨折患者（2016 年 1 月至 2016 年 4 月）。排除接受顾问服务入院或出院的患者。主要结局是开具阿片类药物处方的出院患者比例。数据使用筛查清单、电子记录和观察者间一致性进行收集。我们计算了简单描述性统计和多变量分析。
我们共纳入 816 例患者，其中 441 例女性（54.0%）。最常见的骨折部位是手腕/手部（35.2%）。260 例（31.8%）患者出院时开具了阿片类药物处方；氢吗啡酮（N = 115，范围 1-120mg）最常见。35 例（4.3%）患者在出院后 1 个月内因疼痛相关问题再次到 ED 就诊。腰椎（OR 10.78[95%CI：3.15-36.90]）和肋骨/胸骨/胸椎骨折（OR 5.46[95%CI：2.88-10.35]）的患者开具阿片类药物处方的可能性明显更高。
大多数到 ED 就诊的急性骨折患者未开具阿片类药物处方。氢吗啡酮是最常用的阿片类药物，总剂量差异较大。总体而言，很少有患者返回 ED 就诊。我们建议对 ED 阿片类药物处方进行标准化，注意限制总剂量。
