Blizard Institute for Neuroscience, Surgery, and Trauma, Barts and The London School of Medicine.
Department of Emergency Medicine, The Royal London Hospital and Barts Health NHS Trust, London, UK.
Eur J Emerg Med. 2024 Oct 1;31(5):332-338. doi: 10.1097/MEJ.0000000000001143. Epub 2024 May 27.
Suboptimal acute pain care has been previously reported to be associated with demographic characteristics.
The aim of this study was to assess a healthcare system's multi-facility database of emergency attendances for abdominal pain, to assess for an association between demographics (age, sex, and ethnicity) and two endpoints: time delay to initial analgesia (primary endpoint) and selection of an opioid as the initial analgesic (secondary endpoint).
DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study assessed four consecutive months' visits by adults (≥18 years) with a chief complaint of abdominal pain, in a UK National Health Service Trust's emergency department (ED). Data collected included demographics, pain scores, and analgesia variables.
Categorical data were described with proportions and binomial exact 95% confidence intervals (CIs). Continuous data were described using median (with 95% CIs) and interquartile range (IQR). Multivariable associations between demographics and endpoints were executed with quantile median regression (National Health Service primary endpoint) and logistic regression (secondary endpoint).
In 4231 patients, 1457 (34.4%) receiving analgesia had a median time to initial analgesia of 110 min (95% CI, 104-120, IQR, 55-229). The univariate assessment identified only one demographic variable, age decade ( P = 0.0001), associated with the time to initial analgesia. Association between age and time to initial analgesia persisted in multivariable analysis adjusting for initial pain score, facility type, and time of presentation; for each decade increase the time to initial analgesia was linearly prolonged by 6.9 min (95% CI, 1.9-11.9; P = 0.007). In univariable assessment, time to initial analgesia was not associated with either detailed ethnicity (14 categories, P = 0.109) or four-category ethnicity ( P = 0.138); in multivariable analysis ethnicity remained non-significant as either 14-category (all ethnicities' P ≥ 0.085) or four-category (all P ≥ 0.138). No demographic or operational variables were associated with the secondary endpoint; opioid initial choice was associated only with pain score ( P = 0.003).
In a consecutive series of patients with abdominal pain, advancing age was the only demographic variable associated with prolonged time to initial analgesia. Older patients were found to have a linearly increasing, age-dependent risk for prolonged wait for pain care.
先前有研究表明，急性疼痛护理效果不佳与人口统计学特征有关。
本研究旨在评估一个医疗系统的多设施急诊腹痛就诊患者数据库，以评估人口统计学因素（年龄、性别和种族）与两个结局之间的关系：初始镇痛的时间延迟（主要结局）和选择阿片类药物作为初始镇痛剂（次要结局）。
设计、地点和参与者：这是一项回顾性观察性研究，评估了英国国民保健署信托基金急诊科连续四个月就诊的成年患者（≥18 岁）的主要症状为腹痛。收集的数据包括人口统计学、疼痛评分和镇痛变量。
分类数据用比例和二项精确 95%置信区间（CI）表示。连续数据用中位数（95%CI）和四分位距（IQR）表示。使用分位数中位数回归（国家医疗服务主要结局）和逻辑回归（次要结局）对人口统计学因素与结局之间的关系进行多变量分析。
在 4231 例接受镇痛治疗的患者中，1457 例（34.4%）的初始镇痛时间中位数为 110 分钟（95%CI，104-120，IQR，55-229）。单变量评估仅确定了一个人口统计学变量，年龄十年（P=0.0001），与初始镇痛时间有关。在调整初始疼痛评分、就诊地点和就诊时间后，年龄与初始镇痛时间之间的关联在多变量分析中仍然存在；每增加一个十年，初始镇痛时间线性延长 6.9 分钟（95%CI，1.9-11.9；P=0.007）。在单变量评估中，初始镇痛时间与详细的种族（14 个类别，P=0.109）或四分类种族（P=0.138）均无关；在多变量分析中，种族仍然没有统计学意义，无论是 14 分类（所有种族 P≥0.085）还是四分类（所有 P≥0.138）。没有人口统计学或操作变量与次要结局相关；阿片类药物的初始选择仅与疼痛评分相关（P=0.003）。
在一系列连续的腹痛患者中，年龄是与初始镇痛时间延长唯一相关的人口统计学变量。年龄较大的患者等待疼痛治疗的时间呈现出线性增加的、与年龄相关的风险。
