title: The influence of chief complaint on opioid use in the emergency department.
abstract: The aim of this study was to explore factors influencing emergency department (ED) clinicians' use of opioids in treating selected patients. Patients who either received or did not receive opioids in the ED, as well as their nurses and physicians, were interviewed before patient discharge. We found that the decrease in patients' mean (SD) pain intensity from the time of admission to the ED (7.3 +/- 2.4 on a 0 to 10 numeric rating scale) to discharge (5.0 +/- 2.9) was statistically significant (t93 = 8.4, p < 0.001, 95 percent CI = 1.7, 2.8) for all groups except those with trauma-related pain. The factor that most frequently led physicians of patients with abdominal pain and nurses in general to administer no opioids was that the patient was "not in that much pain." However, the patients in question had self-reported pain scores that indicated moderate pain. Our findings lead us to conclude that clinicians inaccurately infer severity of patient pain. This in turn can influence the prescription of opioids and the patient's decrease in pain.
authors.affiliation: University of California, San Francisco School of Nursing, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Puntillo
authors.forename: Martha
authors.initials: M
authors.lastname: Neighbor
authors.forename: Garrett K
authors.initials: GK
authors.lastname: Chan
authors.forename: Roxanne
authors.initials: R
authors.lastname: Garbez
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010147:Pain Measurement / Q000379:methods; D010820:Physicians
chemical_list: D000701:Analgesics, Opioid