Affiliation:
1. Blizard Institute for Neuroscience, Surgery, and Trauma, Barts and The London School of Medicine
2. Department of Emergency Medicine, The Royal London Hospital and Barts Health NHS Trust, London, UK
3. Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston
4. Department of Immunology and Molecular Microbiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
Abstract
Background and importance
Suboptimal acute pain care has been previously reported to be associated with demographic characteristics.
Objectives
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.
Outcome measures and analysis
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).
Main results
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).
Conclusion
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Reference18 articles.
1. Inadequate analgesia in emergency medicine.;Rupp;Ann Emerg Med,2004
2. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain.;Chen;Acad Emerg Med,2008
3. Problems and barriers of pain management in the emergency department: are we ever going to get better?;Motov;J Pain Res,2008
4. The association between patient visit demographics and opioid analgesic received in the emergency department.;Richards;Cureus,2019
5. Disparities in opioid pain management for long bone fractures.;Benzing;J Racial Ethn Health Disparities,2020