Factors Affecting Emergency Department Opioid Administration to Severely Injured Patients
Corresponding Author
Martha L. Neighbor MD
Department of Medicine (MLN), School of Medicine (SH), and Department of Epidemiology and Biostatistics (MAK), University of California, San Francisco, San Francisco, CA
San Francisco General Hospital Emergency Services (MLN), San Francisco, CA.
Emergency Services 1E21, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110. Fax: 415-206-5818;; e-mail: [email protected]Search for more papers by this authorSamantha Honner MD
Department of Medicine (MLN), School of Medicine (SH), and Department of Epidemiology and Biostatistics (MAK), University of California, San Francisco, San Francisco, CA
Search for more papers by this authorMichael A. Kohn MD, MPP
Department of Medicine (MLN), School of Medicine (SH), and Department of Epidemiology and Biostatistics (MAK), University of California, San Francisco, San Francisco, CA
Search for more papers by this authorCorresponding Author
Martha L. Neighbor MD
Department of Medicine (MLN), School of Medicine (SH), and Department of Epidemiology and Biostatistics (MAK), University of California, San Francisco, San Francisco, CA
San Francisco General Hospital Emergency Services (MLN), San Francisco, CA.
Emergency Services 1E21, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110. Fax: 415-206-5818;; e-mail: [email protected]Search for more papers by this authorSamantha Honner MD
Department of Medicine (MLN), School of Medicine (SH), and Department of Epidemiology and Biostatistics (MAK), University of California, San Francisco, San Francisco, CA
Search for more papers by this authorMichael A. Kohn MD, MPP
Department of Medicine (MLN), School of Medicine (SH), and Department of Epidemiology and Biostatistics (MAK), University of California, San Francisco, San Francisco, CA
Search for more papers by this authorAbstract
Objectives: Studies of emergency department (ED) pain management in patients with trauma have been mostly restricted to patients with fractures, yet the potential for undertreatment of more severely injured patients is great. The authors sought to identify factors associated with failure to receive ED opioid administration in patients with acute trauma who subsequently required hospitalization. Methods: At an urban Level 1 trauma center and teaching hospital, a retrospective cohort study of trauma team activation patients requiring hospitalization between January 1 and December 31, 1999, was conducted. The authors excluded patients receiving opioids only within ten minutes of chest tube insertion or fracture manipulation. The main outcome measure was ED opioid administration. Results: A total of 540 charts of hospitalized first-tier trauma team activation patients were reviewed. A total of 258 (47.8%) received intravenous opioid analgesia within three hours of ED arrival. The median time to receiving the first dose of opioids was 95 minutes. Patients were independently less likely to receive opioids if they were younger or older, were intubated, had a lower Revised Trauma Score, or did not require fracture manipulation. Patients with these factors were less likely to receive opioids independent of the amount of time they spent in the ED. Conclusions: Many trauma activation patients requiring hospitalization do not receive opioid analgesia in the ED. Patients at particular risk for oligoanalgesia include those who are younger or older and those who are more seriously injured, as defined by a lower Revised Trauma Score, lower Glasgow Coma Scale score, and intubation.
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