Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
Emergency Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.
Emerg Med J. 2021 Jun;38(6):467-473. doi: 10.1136/emermed-2020-210215. Epub 2021 Apr 14.
Sex differences in pain experience and expression may influence ED pain management. Our objective was to evaluate the effect of sex on ED opioid administration.
We conducted a multicentre population-based observational cohort study using administrative data from Calgary's four EDs between 2017 and 2018. Eligible patients had a presenting complaint belonging to one of nine pain categories or an arrival pain score >3. We performed multivariable analyses to identify predictors of opioid administration and stratified analyses by age, pain severity and pain category.
We studied 119 510 patients (mean age 47.4 years; 55.4% female). Opioid administration rates were similar for men and women. After adjusting for age, hospital site, pain category, ED length of stay and pain severity, male sex was not a predictor of opioid treatment (adjusted OR (aOR)=0.93; 95% CI 0.85 to 1.02). However, men were more likely to receive opioids in the categories of trauma (aOR=1.58, 95% CI 1.40 to 1.78), flank pain (aOR=1.24, 95% CI 1.11 to 1.38), headache (aOR=1.18, 95% CI 1.03 to 1.34) and abdominal pain (aOR=1.11, 95% CI 1.08 to 1.18). Pain category appears to be a strong determinant of opioid administration, especially back pain (aOR=6.56, 95% CI 5.99 to 7.19) and flank pain (aOR=6.04, 95% CI 5.48 to 6.65). There was significant variability in opioid provision by ED site (aOR 0.76 to 1.24).
This population-based study demonstrated high variability in opioid use across different settings. Overall, men and women had similar likelihood of receiving opioids; however men with trauma, flank pain, headache and abdominal pain were much more likely to receive opioids. ED physicians should self-examine their analgesic practices with respect to possible sex biases, and departments should introduce evidence-based, indication-specific analgesic protocols to reduce practice variability and optimise opioid analgesia.
疼痛体验和表达方面的性别差异可能会影响勃起功能障碍（ED）的疼痛管理。我们的目的是评估性别对 ED 阿片类药物管理的影响。
我们使用了 2017 年至 2018 年卡尔加里四家急诊室的行政数据，进行了一项多中心基于人群的观察性队列研究。符合条件的患者的就诊主诉属于九个疼痛类别之一，或到达疼痛评分为>3。我们进行了多变量分析，以确定阿片类药物给药的预测因素，并按年龄、疼痛严重程度和疼痛类别进行分层分析。
我们研究了 119510 名患者（平均年龄 47.4 岁；55.4%为女性）。男性和女性的阿片类药物给药率相似。在调整年龄、医院地点、疼痛类别、急诊室留观时间和疼痛严重程度后，男性性别不是阿片类药物治疗的预测因素（调整后的比值比[aOR]=0.93；95%置信区间[CI]0.85 至 1.02）。然而，男性更有可能在创伤（aOR=1.58，95%CI 1.40 至 1.78）、侧腹痛（aOR=1.24，95%CI 1.11 至 1.38）、头痛（aOR=1.18，95%CI 1.03 至 1.34）和腹痛（aOR=1.11，95%CI 1.08 至 1.18）类别中接受阿片类药物。疼痛类别似乎是阿片类药物给药的一个强有力决定因素，尤其是背痛（aOR=6.56，95%CI 5.99 至 7.19）和侧腹痛（aOR=6.04，95%CI 5.48 至 6.65）。不同急诊室（aOR 0.76 至 1.24）的阿片类药物供应存在显著差异。
这项基于人群的研究表明，不同环境下阿片类药物的使用存在很大差异。总体而言，男性和女性接受阿片类药物的可能性相似；然而，患有创伤、侧腹痛、头痛和腹痛的男性更有可能接受阿片类药物。急诊医师应检查其镇痛实践是否存在可能的性别偏见，科室应引入基于证据的、针对特定适应症的镇痛方案，以减少实践差异并优化阿片类药物镇痛效果。
