Analgesic use in emergency department patients with fractures

Abstract

Study objectives: The objective of this study is to examine emergency department (ED) treatment of pain in patients with fractures. Methods: Data analyzed in this study were from the National Hospital Ambulatory Medical Care Survey. Patient selection was based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Results: From 46,725 patients analyzed from 1999 and 2000, fractures represented an estimated 8.4 million, or 4%, of US ED visits. The mean age of patients presenting to the ED with fractures was 39±26 years, 54% of these patients were men, and 74% were white. Patients presented to the ED in severe (9%), moderate (25%), or mild (20%) pain. Pain medication was given to 64% of patients, and an oral medication was used for 64% of these patients. Administration of narcotics occurred in 42% of patients, and 16% received nonnarcotic pain medication. The most frequently administered medications were ibuprofen (16%), hydrocodone (15%), acetaminophen (10%), meperidine (8%), and codeine (6%). Patients presenting with severe or moderate pain were 15% more likely to be administered pain medication than patients with less pain (70% versus 61%, adjusted odds ratio [OR]=1.3, P =.01), and these patients in severe or moderate pain were more likely to receive a parenteral medication (33% versus 17%, adjusted OR=2.4, P =.01). Patients 65 years or older (38% versus 10%, adjusted OR=3.9, P =.01), patients in severe or moderate pain (22% versus 9%, adjusted OR=1.9, P =.01), and patients receiving a parenteral narcotic (30% versus 13%, adjusted OR=3.0, P =.01) were more likely to be admitted. Patients younger than 15 years (5% versus 19%, adjusted OR=0.4, P =.01) were less likely to be admitted. Conclusion: ED patients with fractures frequently receive a pain medication, most often a narcotic or nonsteroidal anti-inflammatory drug. Although elderly patients, patients in severe or moderate pain, and patients receiving parenteral narcotics were more likely to be hospitalized, children most often could be treated without hospitalization.