Sevcik Bill, Lobay Kevin, Luu Huong, Martins Karen J B, Vu Khanh, Nguyen Phuong Uyen, Bohlouli Solmaz, Eurich Dean T, Lester Erica L W, Williamson Tyler, Richer Lawrence, Klarenbach Scott W
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Pain Ther. 2023 Aug;12(4):1039-1053. doi: 10.1007/s40122-023-00521-1. Epub 2023 Jun 3.
A better understanding of current acute pain-driven analgesic practices within the emergency department (ED) and upon discharge will provide foundational information in this area, as few studies have been conducted in Canada.
Administrative data were used to identify adults with a trauma-related ED visit in the Edmonton area in 2017/2018. Characteristics of the ED visit included time from initial contact to analgesic administration, type of analgesics dispensed during and upon being discharged home directly from the ED (≤ 7 days after), and patient characteristics.
A total of 50,950 ED visits by 40,505 adults with trauma were included. Analgesics were administered in 24.2% of visits, of which non-opioids were dispensed in 77.0% and opioids were dispensed in 49.0%. Time to analgesic initiation occurred more than 2 h after first contact. Upon discharge, 11.5% received a non-opioid and 15.2% received an opioid analgesic, among whom 18.5% received a daily dose ≥ 50 morphine milligram equivalents (MME) and 30.2% received > 7 days of supply. Three hundred and seventeen adults newly met criteria for chronic opioid use after the ED visit, among whom 43.5% received an opioid dispensation upon discharge; of these individuals, 26.8% had a daily dose ≥ 50 MME and 65.9% received > 7 days of supply.
Findings can be used to inform optimization of analgesic pharmacotherapy practices for the treatment of acute pain, which may include reducing the time to initiation of analgesics in the ED, as well as close consideration of recommendations for acute pain management upon discharge to provide ideal patient-centered, evidence-informed care.
鉴于加拿大在此领域开展的研究较少，更好地了解急诊科（ED）当前针对急性疼痛的镇痛方法以及出院时的情况，将为该领域提供基础信息。
利用行政数据识别2017/2018年在埃德蒙顿地区因创伤到急诊科就诊的成年人。急诊科就诊的特征包括从首次接触到给予镇痛药物的时间、在急诊科期间及直接从急诊科出院回家时（出院后≤7天）所给予的镇痛药物类型以及患者特征。
共纳入40505名因创伤就诊的成年人的50950次急诊科就诊记录。24.2%的就诊给予了镇痛药物，其中77.0%给予了非阿片类药物，49.0%给予了阿片类药物。镇痛药物开始使用时间在首次接触后超过2小时。出院时，11.5%的患者接受了非阿片类药物，15.2%的患者接受了阿片类镇痛药物，其中18.5%的患者接受的每日剂量≥50毫克吗啡当量（MME），30.2%的患者接受的供应时间超过7天。317名成年人在急诊科就诊后新符合慢性阿片类药物使用标准，其中43.5%的患者出院时接受了阿片类药物配药；在这些患者中，26.8%的患者每日剂量≥50 MME，65.9%的患者接受的供应时间超过7天。
研究结果可用于指导优化急性疼痛治疗的镇痛药物治疗方法，这可能包括缩短急诊科开始使用镇痛药物的时间，以及在出院时密切考虑急性疼痛管理建议，以提供理想的以患者为中心的、基于证据的护理。
