Risk Factors for Delayed Analgesia in Patients presenting to the Emergency Department with Long Bone Fractures
Jose Mejia, M.D., Nidhi Garg, M.D., Vamshi Reddy, M.D., Ferleine Bautista, M.D., Michael Radeos, M.D.
Oligoanalgesia has been identified as a problem area in emergency medicine. We sought to determine the causes for delayed administration of analgesics in adults presenting to the emergency department (ED) with long bone fractures.
Methods: Retrospective review of consecutive adult patients presenting to an urban level I Trauma Center ED with a long bone fracture. Patients were excluded if they were age 17 or less or involved in a major trauma. We examined demographic and clinical data, mode of arrival (MOA) and time to analgesic administration. Data were analyzed using chi-square and Kruskal-Wallis test for non-parametric data as needed. Logistic regression was performed and odds ratios (OR) with 95% confidence intervals (95% CI) were used. Alpha was set at 0.05 by convention.
Results: 615 total patients were enrolled between 7/1/06 and 11/30/06. 407 (66.2%) were female, Age groups were 18-39 (75 [12.2%]), 40-64 (168 [27.3%]) and 65 and above 372 (60.5%). More than a dozen languages were represented in our patient population, with 393 (63.9%) speaking English as their primary language. 338 (55.1%) were white, 40 (6.5%) were Black, 63 (10.3%) were Latino 123 (20.0%) were Asian or Pacific Islander and 50 (8.1%) were other race. 402 (66.0%) of our patients arrived via EMS. 301 (65.4%) patients experienced a delay in getting analgesia. Delay was statistically significantly related to age (209 (74.1%) of those 65 and older); OR 1.84 (95% CI [1.35,2.50]) p<0.001. There was no delay associated with either race or English speaking ability. Neither was delay associated with sex or mode of arrival. The effect remained quite significant even when adjusting for sex age race, English language preference and mode of arrival.
Conclusion: There does appear to be a delay in older emergency department patients getting timely analgesia when they have suffered a long bone fracture. Future studies should focus on how to overcome barriers to rapid pain relief for all of our patients, especially the elderly.