TY - JOUR
T1 - Factors associated with refractory pain in emergency patients admitted to emergency general surgery
AU - Gilliam, William
AU - Barr, Jackson F.
AU - Bruns, Brandon
AU - Cave, Brandon
AU - Mitchell, Jordan
AU - Nguyen, Tina
AU - Palmer, Jamie
AU - Rose, Mark
AU - Tanveer, Safura
AU - Yum, Chris
AU - Tran, Quincy K.
N1 - Funding Information:
Funding: The authors received no financial support for the investigation and the development of this manuscript. Ethical approval: The study was approved by our institution review board. Conflicts of interest: The authors have no conflict of interest to declare. Contributors: WG, BB, QKT: concept and study design; WG, JFB, BC, JM, TN, JP, MR, ST: data acquisition, data quality, and analysis. All authors participated in the drafting and critical revision of the manuscript.
Publisher Copyright:
© 2021 World Journal of Emergency Medicine.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previous study reported that emergency providers did not adequately manage patients with severe pain despite objective findings for surgical pathologies. Our study aims to investigate clinical and laboratory factors, in addition to providers' interventions, that might have been associated with oligoanalgesia in a group of ED patients with moderate and severe pains due to surgical pathologies. METHODS: We conducted a retrospective study of adult patients who were transferred directly from referring EDs to the emergency general surgery (EGS) service at a quaternary academic center between January 2014 and December 2016. Patients who were intubated, did not have adequate records, or had mild pain were excluded. The primary outcome was refractory pain, which was defi ned as pain reduction <2 units on the 0-10 pain scale between triage and ED departure. RESULTS: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory pain had signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and less frequent pain medication administration (median [interquartile range], 3 [3-5] vs. 4 [3-7], P=0.001), when compared to patients with no refractory pain. Multivariable logistic regression showed that the number of pain medication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68-0.98) and ED serum lactate levels (OR 3.80, 95% CI 2.10-6.80) were signifi cantly associated with the likelihood of refractory pain. CONCLUSIONS: In ED patients transferring to EGS service, elevated serum lactate levels were associated with a higher likelihood of refractory pain. Future studies investigating pain management in patients with elevated serum lactate are needed.
AB - BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previous study reported that emergency providers did not adequately manage patients with severe pain despite objective findings for surgical pathologies. Our study aims to investigate clinical and laboratory factors, in addition to providers' interventions, that might have been associated with oligoanalgesia in a group of ED patients with moderate and severe pains due to surgical pathologies. METHODS: We conducted a retrospective study of adult patients who were transferred directly from referring EDs to the emergency general surgery (EGS) service at a quaternary academic center between January 2014 and December 2016. Patients who were intubated, did not have adequate records, or had mild pain were excluded. The primary outcome was refractory pain, which was defi ned as pain reduction <2 units on the 0-10 pain scale between triage and ED departure. RESULTS: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory pain had signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and less frequent pain medication administration (median [interquartile range], 3 [3-5] vs. 4 [3-7], P=0.001), when compared to patients with no refractory pain. Multivariable logistic regression showed that the number of pain medication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68-0.98) and ED serum lactate levels (OR 3.80, 95% CI 2.10-6.80) were signifi cantly associated with the likelihood of refractory pain. CONCLUSIONS: In ED patients transferring to EGS service, elevated serum lactate levels were associated with a higher likelihood of refractory pain. Future studies investigating pain management in patients with elevated serum lactate are needed.
KW - Emergency department
KW - Emergency general surgery
KW - Refractory pain
KW - Serum lactate
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U2 - 10.5847/WJEM.J.1920-8642.2021.01.002
DO - 10.5847/WJEM.J.1920-8642.2021.01.002
M3 - Article
AN - SCOPUS:85120861658
SN - 1920-8642
VL - 12
SP - 12
EP - 17
JO - World Journal of Emergency Medicine
JF - World Journal of Emergency Medicine
IS - 1
ER -