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A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic.

Publication ,  Journal Article
Lazio, MP; Costello, HH; Courtney, DM; Martinovich, Z; Myers, R; Zosel, A; Tanabe, P
Published in: The Clinical journal of pain
March 2010

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.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.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).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.

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Published In

The Clinical journal of pain

DOI

EISSN

1536-5409

ISSN

0749-8047

Publication Date

March 2010

Volume

26

Issue

3

Start / End Page

199 / 205

Related Subject Headings

  • Triage
  • Time Factors
  • Statistics, Nonparametric
  • Retrospective Studies
  • Renal Colic
  • Quality of Health Care
  • Proportional Hazards Models
  • Pain Measurement
  • Pain
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
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Lazio, M. P., Costello, H. H., Courtney, D. M., Martinovich, Z., Myers, R., Zosel, A., & Tanabe, P. (2010). A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic. The Clinical Journal of Pain, 26(3), 199–205. https://doi.org/10.1097/ajp.0b013e3181bed10c
Lazio, Matthew P., Heather H. Costello, D Mark Courtney, Zoran Martinovich, Randall Myers, Amy Zosel, and Paula Tanabe. “A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic.The Clinical Journal of Pain 26, no. 3 (March 2010): 199–205. https://doi.org/10.1097/ajp.0b013e3181bed10c.
Lazio MP, Costello HH, Courtney DM, Martinovich Z, Myers R, Zosel A, et al. A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic. The Clinical journal of pain. 2010 Mar;26(3):199–205.
Lazio, Matthew P., et al. “A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic.The Clinical Journal of Pain, vol. 26, no. 3, Mar. 2010, pp. 199–205. Epmc, doi:10.1097/ajp.0b013e3181bed10c.
Lazio MP, Costello HH, Courtney DM, Martinovich Z, Myers R, Zosel A, Tanabe P. A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic. The Clinical journal of pain. 2010 Mar;26(3):199–205.

Published In

The Clinical journal of pain

DOI

EISSN

1536-5409

ISSN

0749-8047

Publication Date

March 2010

Volume

26

Issue

3

Start / End Page

199 / 205

Related Subject Headings

  • Triage
  • Time Factors
  • Statistics, Nonparametric
  • Retrospective Studies
  • Renal Colic
  • Quality of Health Care
  • Proportional Hazards Models
  • Pain Measurement
  • Pain
  • Middle Aged