title: Patient-controlled analgesia compared with interval analgesic dosing for reducing complications in blunt thoracic trauma: a retrospective cohort study.
abstract: OBJECTIVE
  To determine if complications from blunt thoracic trauma are reduced with patient-controlled analgesia (PCA) compared with interval analgesic dosing given as needed. Secondary aims were to investigate the influence of PCA on hospital length of stay (LOS) and cost.
  
  
  METHODS
  In this retrospective cohort study, patients were identified using the hospital trauma registry and clinical information department. Data on analgesic method, outcomes and confounders were obtained from the medical record. Costing data were obtained from the case-mix department. The analysis used logistic regression for the primary outcome and a generalised linear model for the secondary outcomes to adjust for potential confounders.
  
  
  RESULTS
  227 patients were included. In the PCA group, 17/52 (33%) patients had a complication compared with 26/175 (15%) in the interval dosing group. The adjusted odds for a complication in patients receiving PCA was not significantly different from the adjusted odds in those receiving interval dosing (OR=1.2, 95% CI 0.3 to 4.6, p=0.83). The median LOS was 8.9 days in the PCA group and 4.6 days in the interval dosing group. The adjusted LOS for patients receiving PCA was 10% shorter than those receiving interval dosing (relative difference 0.9, 95% CI 0.6 to 1.3, p=0.52). The median hospital cost was $A11 107 in the PCA group (IQR $A7520-$A15 744) and $A4511 (IQR $A2687-$A8248) in the interval dosing group. The adjusted total hospital costs for patients receiving PCA was 10% higher than for those receiving interval dosing (relative difference 1.1, 95% CI 0.8 to 1.5, p=0.44).
  
  
  CONCLUSIONS
  PCA did not reduce complications, hospital LOS or costs compared with interval analgesic dosing.
authors.affiliation: Department of Emergency, St George Hospital, , Sydney, New South Wales, Australia.
authors.forename: Stephen Edward
authors.initials: SE
authors.lastname: Asha
authors.forename: Kate Anne
authors.initials: KA
authors.lastname: Curtis
authors.forename: Colman
authors.initials: C
authors.lastname: Taylor
authors.forename: Allan
authors.initials: A
authors.lastname: Kwok
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000191:economics; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications* / Q000188:drug therapy; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid