Objectives
The authors sought to describe the frequency of short‐term side effects experienced by older adults initiating treatment with opioid‐containing analgesics for acute musculoskeletal pain.
...Methods
This was a cross‐sectional study of individuals age 65 years or older initiating analgesic treatment following emergency department (ED) visits for acute musculoskeletal pain. Patients were called by phone 4 to 7 days after their ED visits to assess the intensity of six common opioid‐related side effects using a 0 to 10 scale and to assess medication discontinuation due to side effects. Propensity score matching was used to compare side effects among patients initiating treatment with any opioid‐containing analgesics to side effects among those initiating treatment with only nonopioids.
Results
Of 104 older patients initiating analgesic treatment following ED visits for musculoskeletal pain, 71 patients took opioid‐containing analgesics, 15 took acetaminophen, and 18 took ibuprofen. Among the patients who took opioids, at least one side effect of moderate or severe intensity (score ≥ 4) was reported by 62%. Among patients with matching propensity scores, those taking opioids were more likely to have had moderate or severe side effects than those taking only nonopioids (62%, 95% confidence interval CI = 48% to 74% vs. 4%, 95% CI = 1% to 20%) and were also more likely to have discontinued treatment due to side effects (16%, 95% CI = 8% to 29% vs. 0%, 95% CI = 0% to 13%). The most common side effects due to opioids were tiredness, nausea, and constipation.
Conclusions
Among older adults initiating treatment with opioid‐containing analgesics for musculoskeletal pain, side effects were common and sometimes resulted in medication discontinuation.
Resumen
Efectos Secundarios de los Opioides Orales Utilizados para Tratar el Dolor Agudo Músculoesquelético en Adultos Mayores Durante la Primera Semana de Tratamiento
Objetivos
Describir la frecuencia de los efectos secundarios a corto plazo experimentados por los adultos mayores que inician tratamiento con un analgésico que contiene opioides para el dolor agudo musculoesquelético.
Metodología
Estudio transversal de sujetos de 65 años o más que iniciaron tratamiento analgésico tras una visita al servicio de urgencias (SU) por dolor agudo musculoesquelético. Se contactó con los pacientes por teléfono de 4 a 7 días después de la visita al SU para valorar la intensidad de los seis efectos secundarios más frecuentes relacionados con los opiáceos usando una escala de 0 a 10. Se valoró la interrupción de la medicación debido a los efectos secundarios. Se utilizó el emparejamiento mediante puntuación de propensión (propensity store) para comparar los efectos secundarios entre los pacientes que inician el tratamiento con cualquier analgésico que contiene opioides y los efectos secundarios en aquéllos que inician tratamiento únicamente con no opioides.
Resultados
De los 104 pacientes mayores que iniciaron tratamiento analgésico tras una visita al SU por dolor musculoesquelético, 71 tomaron un analgésico que contenía opioides, 15 acetaminofeno y 18 ibuprofeno. Entre los pacientes que tomaron un opioide, al menos se documentó un efecto secundario de intensidad moderada o grave (puntuación ≥ 4) en el 62% de ellos. Entre los pacientes con emparejamiento mediante puntuaciones de propensión, aquéllos que tomaron opioides tuvieron mayor probabilidad de haber tenido un efecto secundario moderado o grave que aquéllos que tomaron únicamente un no opioide (62%, intervalo de confianza IC 95% = 48% a 74% vs. 4%, IC 95% = 1% a 20%) y también tuvieron mayor probabilidad de haber interrumpido el tratamiento debido a los efectos secundarios (16%, IC 95% = 8% a 29% vs. 0%, IC 95% = 0% a 13%). Los efectos secundarios más frecuentes debido a los opioides fueron cansancio, náuseas y estreñimiento.
Conclusiones
En los adultos mayores que inician tratamiento analgésico que contiene opioides para el dolor musculoesquelético, los efectos secundarios fueron comunes y algunas veces llevaron a la interrupción de la medicación.
Objectives
Emergency departments (EDs) are an increasingly important site of care for older adults, but little is known about the priorities of emergency care in this population. We sought to ...describe and rank priorities of care among older adults receiving care in the ED.
Methods
We conducted a cross‐sectional study of cognitively intact patients aged 65 years and older receiving care in two U.S. EDs. Participants provided up to three open‐ended responses to a single question asking what would make their ED visit successful, useful, or valuable. A literature review and patient responses were used to generate priority categories and larger metacategories. Each response was then assigned to one of the categories by independent reviewers. We report the percentage of patients identifying a priority in each category and metacategory and the relative weight of each category based on the frequency and order of priorities provided by patients.
Results
A total of 185 participants provided 351 priorities. Twenty‐four categories and seven metacategories were identified. Sixty‐two percent (N = 114) of participants reported at least one priority in the “evaluation, treatment, and outcomes” metacategory. Of these, the most common priorities included treatment of the medical problem (n = 37, 20%), accurate diagnosis (n = 36, 19%), competent staff and provider (n = 28, 15%), and desirable health outcome (n = 24, 13%). The second and third most common metacategories were “timely care” (n = 67, 36%), and “service” (n = 38, 21%). Nineteen patients (10%) expressed a desire to be discharged; one patient (1%) expressed a desire for admission. The ranking of weighted priorities were identical to the unweighted rank order by frequency.
Conclusions
Among a sample of cognitively intact older ED patients, the most common priorities were related to the accuracy and efficiency of the medical evaluation. These priorities should be considered by those attempting to improve the emergency care of older adults.
Life-threatening hyperkalemia after 2 days of ibuprofen Platts-Mills, Timothy F., MD; Richmond, Natalie L; Hunold, Katherine M., BSPH ...
The American journal of emergency medicine,
02/2013, Letnik:
31, Številka:
2
Journal Article
Recenzirano
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly recommended for pain treatment in older adults because they are more effective than acetaminophen and lack the central nervous system side ...effects of opioids. Nonsteroidal anti-inflammatory drugs are an important treatment option because they provide more analgesia than acetaminophen and lack the central nervous system side effects of opioids 5,6.
Abstract Study Objective Knowledge of current areas of activity in emergency medicine research may improve collaboration among investigators and may help inform decisions about future research ...priorities. Randomized, controlled trials are a key component of research activity and an essential tool for improving care. We investigated the characteristics of randomized trials recently published in emergency medicine journals. Methods This was a retrospective analysis of randomized trials published in the 5 highest impact emergency medicine journals. PubMed was searched for reports of randomized trials involving human subjects indexed to MEDLINE between January 1, 2008, and December 31, 2011. Included trials were classified with respect to study topic, funding source, presence of age-related inclusion criteria, and country of origin. Results A total of 163 published studies were included for analysis. Pain management was the most commonly studied topic (n = 28, or 17%) followed by orthopedics (n = 24, or 15%), cardiovascular disease (n = 13, or 8%), and prehospital medicine (n = 13, or 8%). Less than half of studies received extramural funding support. Children were specifically examined in 22 (13%) of trials; only 5 trials (3%) specifically examined patients aged 60 or older. Conclusions Emergency medicine journals publish randomized trials addressing a wide range of clinical topics. Randomized trials focusing on geriatric patients are not commonly published in these journals.
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