Factors associated with refractory pain in emergency patients admitted to emergency general surgery

作     者：William Gilliam Jackson FBarr Brandon Bruns Brandon Cave Jordan Mitchell Tina Nguyen Jamie Palmer Mark Rose Safura Tanveer Chris Yum Quincy K.Tran William Gilliam;Jackson F.Barr;Brandon Bruns;Brandon Cave;Jordan Mitchell;Tina Nguyen;Jamie Palmer;Mark Rose;Safura Tanveer;Chris Yum;Quincy K.Tran

作者机构：Johns Hopkins UniversityBaltimore 21218USA Research Associate Program in Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of MedicineBaltimore 21201USA R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Department of SurgeryUniversity of Maryland School of MedicineBaltimore 21201USA Louisiana State UniversityLouisiana 70803USA University of Maryland School of MedicineBaltimore 21201USA Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimore 21201USA 

出 版 物：《World Journal of Emergency Medicine》 (世界急诊医学杂志（英文）)

年 卷 期：2021年第12卷第1期

页      面：12-17页

核心收录：

学科分类：1006[医学-中西医结合] 1002[医学-临床医学] 100602[医学-中西医结合临床] 10[医学] 

基　　金：support for the investigation and the development of this manuscript 

主　　题：Serum lactate Refractory pain Emergency general surgery Emergency department 

摘      要：BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical pathologies. Our study aims to investigate clinical andlaboratory factors, in addition to providers’ interventions, that might have been associated witholigoanalgesia in a group of ED patients with moderate and severe pains due to surgical ***: We conducted a retrospective study of adult patients who were transferred directlyfrom referring EDs to the emergency general surgery (EGS) service at a quaternary academic centerbetween January 2014 and December 2016. Patients who were intubated, did not have adequaterecords, or had mild pain were excluded. The primary outcome was refractory pain, which wasdefi ned as pain reduction 2 units on the 0–10 pain scale between triage and ED ***: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory painhad signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and lessfrequent pain medication administration (median [interquartile range], 3 [3–5] vs. 4 [3–7], P=0.001), whencompared to patients with no refractory pain. Multivariable logistic regression showed that the number of painmedication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68–0.98) and ED serumlactate levels (OR 3.80, 95% CI 2.10–6.80) were signifi cantly associated with the likelihood of refractory ***: In ED patients transferring to EGS service, elevated serum lactate levelswere associated with a higher likelihood of refractory pain.