Brown University School of Public Health, Department of Epidemiology, Providence, Rhode Island.
University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.
West J Emerg Med. 2022 Oct 23;23(6):864-871. doi: 10.5811/westjem.2022.8.56679.
Urolithiasis causes severe acute pain and is commonly treated with opioid analgesics in the emergency department (ED). We examined opioid analgesic use after episodes of acute pain.
Using data from a longitudinal trial of ED patients with urolithiasis, we constructed multivariable models to estimate the adjusted probability of opioid analgesic use 3, 7, 30, and 90 days after ED discharge. We used multiple imputation to account for missing data and weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge. We used weighted multivariable regression to compare longitudinal opioid analgesic use for those prescribed vs not prescribed an opioid analgesic at discharge, stratified by reported pain at ED discharge.
Among 892 adult ED patients with urolithiasis, 79% were prescribed an opioid analgesic at ED discharge. Regardless of reporting pain at ED discharge, those who were prescribed an opioid analgesic were significantly more likely to report using it one, three, and seven days after the visit in weighted multivariable analysis. Among those who were not prescribed an opioid analgesic, an estimated 21% (not reporting pain at ED discharge) and 30% (reporting pain at discharge) reported opioid analgesic use at day three. Among those prescribed an opioid analgesic, 49% (no pain at discharge) and 52% (with pain at discharge) reported using an opioid analgesic at day three.
Urolithiasis patients who received an opioid analgesic at ED discharge were more likely to continue using an opioid analgesic than those who did not receive a prescription at the initial visit, despite the time-limited nature of urolithiasis.
尿路结石会引起严重的急性疼痛，在急诊科（ED）通常使用阿片类镇痛药进行治疗。我们研究了急性疼痛发作后阿片类镇痛药的使用情况。
我们使用来自一项纵向尿路结石患者 ED 研究的数据，构建多变量模型来估计 ED 出院后 3、7、30 和 90 天使用阿片类镇痛药的调整概率。我们使用多重插补法处理缺失数据，并使用加权法处理出院时开具阿片类镇痛药的倾向。我们使用加权多变量回归比较了在 ED 出院时开具和未开具阿片类镇痛药的患者的纵向阿片类镇痛药使用情况，并按 ED 出院时报告的疼痛情况进行分层。
在 892 名患有尿路结石的成年 ED 患者中，79%的患者在 ED 出院时开具了阿片类镇痛药。无论在 ED 出院时报告疼痛与否，在加权多变量分析中，开具阿片类镇痛药的患者在就诊后 1、3 和 7 天报告使用该药的可能性明显更高。在未开具阿片类镇痛药的患者中，估计有 21%（在 ED 出院时未报告疼痛）和 30%（在出院时报告疼痛）在第 3 天报告使用阿片类镇痛药。在开具阿片类镇痛药的患者中，49%（出院时无疼痛）和 52%（出院时疼痛）在第 3 天报告使用阿片类镇痛药。
尽管尿路结石具有时间局限性，但在 ED 出院时开具阿片类镇痛药的尿路结石患者比初次就诊时未开具处方的患者更有可能继续使用阿片类镇痛药。
