Analgesic use in emergency department patients with renal colic

Abstract

Study objectives: Patients with renal colic experience significant pain in the emergency department (ED). This study analyzes the factors that predict ED pain management and disposition. Methods: Data analyzed in this study were from the National Hospital Ambulatory Medical Care Survey for 1999 and 2000. Patient selection was based on ED International Classification of Diseases, Ninth Revision, Clinical Modification codes related to renal colic, renal and ureteral calculi, and hydronephrosis. Adjusted odds ratios (ORs) are presented from logistic regression. Results: The 407 patients with renal colic and associated disorders represent 1.8 million, or 0.9%, of the ED patient visits. These patients were 42±15 years old, 65% were men, 77% were white, and 15% required hospitalization. Of the 260 (64%) patients who had documented pain evaluation in the ED, 102 (25%) reported having severe pain and 102 (25%) moderate pain. In the 85% of patients who received a pain medication, the most commonly used medication class was the narcotics (68%), and the most frequently used individual medications were ketorolac (47%), hydrocodone (23%), promethazine (22%), meperidine (21%), and morphine (15%). Patients presenting with severe or moderate pain were 18% more likely to receive a narcotic than patients with lesser pain (91% versus 77%, adjusted OR=3.4, P<.01). Antiemetics were provided to 34% of patients and were 3.8 times more likely to be given to patients who received a narcotic (45% versus 12%, adjusted OR=4.9, P<.01). Patients who received a parenteral narcotic were 2.2 times more likely to be admitted (22% versus 10%, adjusted OR=4.6, P=.01). Conclusion: Patients presenting with the severe pain associated with renal colic were most often treated with narcotics, and those treated with narcotics were more likely to receive an antiemetic. Patients who received a parenteral narcotic were more likely to be admitted for their painful condition. Study objectives: Patients with renal colic experience significant pain in the emergency department (ED). This study analyzes the factors that predict ED pain management and disposition. Methods: Data analyzed in this study were from the National Hospital Ambulatory Medical Care Survey for 1999 and 2000. Patient selection was based on ED International Classification of Diseases, Ninth Revision, Clinical Modification codes related to renal colic, renal and ureteral calculi, and hydronephrosis. Adjusted odds ratios (ORs) are presented from logistic regression. Results: The 407 patients with renal colic and associated disorders represent 1.8 million, or 0.9%, of the ED patient visits. These patients were 42±15 years old, 65% were men, 77% were white, and 15% required hospitalization. Of the 260 (64%) patients who had documented pain evaluation in the ED, 102 (25%) reported having severe pain and 102 (25%) moderate pain. In the 85% of patients who received a pain medication, the most commonly used medication class was the narcotics (68%), and the most frequently used individual medications were ketorolac (47%), hydrocodone (23%), promethazine (22%), meperidine (21%), and morphine (15%). Patients presenting with severe or moderate pain were 18% more likely to receive a narcotic than patients with lesser pain (91% versus 77%, adjusted OR=3.4, P<.01). Antiemetics were provided to 34% of patients and were 3.8 times more likely to be given to patients who received a narcotic (45% versus 12%, adjusted OR=4.9, P<.01). Patients who received a parenteral narcotic were 2.2 times more likely to be admitted (22% versus 10%, adjusted OR=4.6, P=.01). Conclusion: Patients presenting with the severe pain associated with renal colic were most often treated with narcotics, and those treated with narcotics were more likely to receive an antiemetic. Patients who received a parenteral narcotic were more likely to be admitted for their painful condition.