Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
Division of Health Information, Ministry of Health, Jerusalem, Israel.
Am J Emerg Med. 2023 Sep;71:31-36. doi: 10.1016/j.ajem.2023.05.038. Epub 2023 Jun 1.
Analgesic treatment, including with opioids, can safely be given to patients who are suspected of having appendicitis. The study examined factors which may influence the treatment of pain in appendicitis in the adult emergency department (ED). A secondary objective was to determine if analgesia affected clinical outcomes.
This single-center retrospective study examined medical records of all adult patients with a discharge diagnosis of appendicitis. Patients were categorized based on the type of analgesia received in the ED. Variables included the day of week and staffing shift of presentation, gender, age, and triage pain scale, as well as time to ED discharge, imaging, operation, and hospital discharge. Univariable and multivariable logistic regression models were performed to determine which factors influenced treatment and affected outcomes.
Records of 1839 patients were categorized into three groups - 883 (48%) did not receive analgesia, 571 (31%) received only non-opioid medications, and 385 (21%) received at least one opioid. Patients with a higher triage pain level were significantly more likely to receive analgesia (4-6: OR = 1.85; 95% CI = 1.2-2.84, 7-9: OR = 3.36; 95% CI = 2.18-5.17, 10: OR = 10.78; 95% CI = 6.38-18.23) and at least one opioid (4-6: OR = 2.88; 95% CI = 1.13-7.34, 7-9: OR = 4.36; 95% CI = 1.73-11.01, 10: OR = 6.23; 95% CI = 2.42-16.09). Male gender was associated with a significantly lower likelihood of receiving analgesia (OR = 0.74; 95% CI = 0.61-0.9), but a significantly greater likelihood of receiving at least one opioid given that they received any pain medication (OR = 1.87; 95% CI = 1.41-2.48). Patients aged 25-64 years old were significantly more likely to receive at least one opioid if they received any pain medication (25-44: OR = 1.47; 95% CI = 1.08-2.02, 45-64: OR = 1.78; 95% CI = 1.15-2.76). Presentation to the ED on Sundays was associated with lower rates of opioid treatment (OR = 0.63; 95% CI = 0.42-0.94). Regarding clinical outcomes, patients who received analgesia waited longer for imaging (+0.58 h; 95% CI = 0.31-0.85), stayed longer in the ED (+2.2 h; 95% CI = 1.60-2.79), and had a slightly longer hospitalization (+0.62d; 95% CI = 0.34-0.90).
Almost half of patients with appendicitis didn't receive analgesia, with most of those treated receiving only non-opioid analgesia. Older age and Sunday presentations were associated with less opioid treatment. Patients who received analgesia waited longer for imaging, stayed longer in the ED, and had a longer hospitalization.
怀疑患有阑尾炎的患者可以安全地接受包括阿片类药物在内的镇痛治疗。本研究调查了可能影响成人急诊科（ED）阑尾炎疼痛治疗的因素。次要目标是确定镇痛是否影响临床结果。
这项单中心回顾性研究检查了所有有阑尾炎出院诊断的成年患者的病历。患者根据在 ED 接受的镇痛类型进行分类。变量包括就诊时的星期几和班次、性别、年龄和分诊疼痛量表，以及 ED 出院、影像学检查、手术和出院的时间。采用单变量和多变量逻辑回归模型确定哪些因素影响治疗并影响结果。
记录了 1839 名患者，分为三组 - 883 名（48%）未接受镇痛，571 名（31%）仅接受非阿片类药物治疗，385 名（21%）接受至少一种阿片类药物。分诊疼痛水平较高的患者更有可能接受镇痛（4-6：OR=1.85；95%CI=1.2-2.84，7-9：OR=3.36；95%CI=2.18-5.17，10：OR=10.78；95%CI=6.38-18.23）和至少一种阿片类药物（4-6：OR=2.88；95%CI=1.13-7.34，7-9：OR=4.36；95%CI=1.73-11.01，10：OR=6.23；95%CI=2.42-16.09）。男性性别与接受镇痛的可能性显著降低（OR=0.74；95%CI=0.61-0.9）相关，但在接受任何疼痛药物治疗的情况下，接受至少一种阿片类药物的可能性显著增加（OR=1.87；95%CI=1.41-2.48）。如果接受任何疼痛药物治疗，25-64 岁的患者接受至少一种阿片类药物的可能性显著增加（25-44：OR=1.47；95%CI=1.08-2.02，45-64：OR=1.78；95%CI=1.15-2.76）。ED 就诊于周日与阿片类药物治疗率降低相关（OR=0.63；95%CI=0.42-0.94）。关于临床结果，接受镇痛的患者等待影像学检查的时间更长（+0.58 小时；95%CI=0.31-0.85），在 ED 停留时间更长（+2.2 小时；95%CI=1.60-2.79），住院时间略长（+0.62 天；95%CI=0.34-0.90）。
几乎一半的阑尾炎患者未接受镇痛治疗，大多数接受治疗的患者仅接受非阿片类镇痛药。年龄较大和周日就诊与阿片类药物治疗减少有关。接受镇痛的患者等待影像学检查的时间更长，在 ED 停留的时间更长，住院时间更长。
