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{
    "pk": 11635,
    "title": "Emergency Providers’ Pain Management in Patients Transferred to Intensive Care Unit for Urgent Surgical Interventions.",
    "subtitle": null,
    "abstract": "Introduction:\n Pain is the most common complaint for an emergency department (ED) visit, but ED pain management is poor. Reasons for poor pain management include providers’ concerns for drug-seeking behaviors and perceptions of patients’ complaints. Patients who had objective findings of long bone fractures were more likely to receive pain medication than those who did not, despite pain complaints. We hypothesized that patients who were interhospital-transferred from an ED to an intensive care unit (ICU) for urgent surgical interventions would display objective pathology for pain and thus receive adequate pain management at ED departure.\nMethods:\n This was a retrospective study at a single, quaternary referral, academic medical center.  We included non-trauma adult ED patients who were interhospital-transferred and underwent operative interventions within 12 hours of ICU arrival between July 2013 and June 2014.  Patients who had incomplete ED records, required invasive mechanical ventilation, or had no pain throughout their ED stay were excluded. Primary outcome was the percentage of patients at ED departure achieving adequate pain control of ≤ 50% of triage level. We performed multivariable logistic regression to assess association between demographic and clinical variables with inadequate pain control.\nResults: \nWe included 112 patients from 39 different EDs who met inclusion criteria. Mean pain score at triage and ED departure was 8 (standard deviation 8 and 5 [3]), respectively. Median of total morphine equivalent unit (MEU) was 7.5 [5-13] and MEU/kg total body weight (TBW) was 0.09 [0.05-0.16] MEU/kg, with median number of pain medication administration of 2 [1-3] doses. Time interval from triage to first narcotic dose was 61 (35-177) minutes. Overall, only 38% of patients achieved adequate pain control. Among different variables, only total MEU/kg was associated with significant lower risk of inadequate pain control at ED departure (adjusted odds ratio = 0.22; 95% confidence interval = 0.05-0.92, p = 0.037).\nConclusion:\n Pain control among a group of interhospital-transferred patients requiring urgent operative interventions, was inadequate. Neither demographic nor clinical factors, except MEU/kg TBW, were shown to associate with poor pain management at ED departure. Emergency providers should consider more effective strategies, such as multimodal analgesia, to improve pain management in this group of patients.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "ED, pain management, emergent surgery"
        }
    ],
    "section": "Pain Management",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/83r4h1z5",
    "frozenauthors": [
        {
            "first_name": "Quincy",
            "middle_name": "K.",
            "last_name": "Tran",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland\nThe R. Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Program of Trauma, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Tina",
            "middle_name": "",
            "last_name": "Nguyen",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Gurshawn",
            "middle_name": "",
            "last_name": "Tuteja",
            "name_suffix": "",
            "institution": "Johns Hopkins University, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Laura",
            "middle_name": "",
            "last_name": "Tiffany",
            "name_suffix": "",
            "institution": "University of Maryland at College Park, College Park, Maryland",
            "department": "None"
        },
        {
            "first_name": "Ashley",
            "middle_name": "",
            "last_name": "Aitken",
            "name_suffix": "",
            "institution": "The R. Adam Cowley Shock Trauma Center, Critical Care Resuscitation Unit, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Kevin",
            "middle_name": "",
            "last_name": "Jones",
            "name_suffix": "",
            "institution": "The R. Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Program of Trauma, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Rebecca",
            "middle_name": "",
            "last_name": "Duncan",
            "name_suffix": "",
            "institution": "The R. Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Program of Trauma, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Jeffrey",
            "middle_name": "",
            "last_name": "Rea",
            "name_suffix": "",
            "institution": "The R. Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Program of Trauma, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Lewis",
            "middle_name": "",
            "last_name": "Rubinson",
            "name_suffix": "",
            "institution": "The R. Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Program of Trauma, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Daniel",
            "middle_name": "",
            "last_name": "Haase",
            "name_suffix": "",
            "institution": "The R. Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Program of Trauma, Baltimore, Maryland",
            "department": "None"
        }
    ],
    "date_submitted": "2018-02-22T22:49:03Z",
    "date_accepted": "2018-02-22T22:49:03Z",
    "date_published": "2018-08-08T19:54:53Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11635/galley/6262/download/"
        }
    ]
}