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A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic. Clin J Pain 2010 Mar-Apr;26(3):199-205

Date

02/23/2010

Pubmed ID

20173433

Pubmed Central ID

PMC3677029

DOI

10.1097/AJP.0b013e3181bed10c

Abstract

OBJECTIVES: To determine whether there is a difference in time to initial analgesic for patients with acute pain from sickle cell disease (SCD) versus renal colic (RC) and to identify factors contributing to variance in time to analgesic.

METHODS: A retrospective cohort study of the adult emergency department (ED) patients with acute pain from SCD and RC in an urban ED (final ED discharge ICD-9 diagnosis codes were included). A structured medical record review abstracted the demographics, arrival shift, triage level, initial pain score, triage time, and time of initial analgesic dose. Data were compared with Kaplan-Meier plots of time to initial analgesic for both RC and SCD with the log-rank test to test for differences by disease category. A multivariable Cox regression model estimated differences in time to initial analgesic by disease category while controlling for other possible confounders.

RESULTS: Median time to initial analgesic was 80 minutes for patients with SCD (interquartile range, 48 to 145) versus 50 minutes for patients with RC (interquartile range: 30 to 96). Patients with SCD reported a higher pain score on arrival when compared with RC patients and were more frequently assigned a higher triage priority level (P=0.05). Covariates that contributed the most delays to the model were afternoon arrival [hazard ratio (HR): 0.35, P<0.01], low acuity triage level (HR: 0.42, P<0.01), SCD diagnosis (HR: 0.61, P<0.01), and inability to obtain intravenous access (HR: 0.71, P=0.01).

DISCUSSION: ED patients with SCD experienced longer delays in the administration of the initial analgesic compared with RC patients, despite higher arrival pain scores and triage acuity levels.

Author List

Lazio MP, Costello HH, Courtney DM, Martinovich Z, Myers R, Zosel A, Tanabe P

Author

Amy Elizabeth Zosel MD Associate Professor in the Emergency Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Analgesics
Anemia, Sickle Cell
Cohort Studies
Emergency Service, Hospital
Female
Hospitals, University
Humans
Illinois
Male
Medical Records
Middle Aged
Pain
Pain Measurement
Proportional Hazards Models
Quality of Health Care
Renal Colic
Retrospective Studies
Statistics, Nonparametric
Time Factors
Triage