title: The effect of surgical consult in the treatment of abdominal pain in older adults in the ED.
abstract: OBJECTIVE
  The objective was to determine whether need for surgical consult contributes to delayed or reduced analgesic administration in older adults presenting to the emergency department with abdominal pain.
  
  
  METHODS
  Secondary data analyses from a prospective cohort study consisting of adults ≥65 years in age presenting to the emergency department with a chief concern of abdominal pain from November 1, 2012, through October 31, 2014, were performed. Measurements included administration of analgesics, time to administration, type given, and pain score reduction. Covariates for adjusted analyses included age, sex, race/ethnicity, and Emergency Severity Index.
  
  
  RESULTS
  A total of 3522 patients were included, of which 281 (8.7%) received any consult. Consult patients were less likely to receive any analgesic medication (53.0%) compared with nonconsult patients (62.5%) (relative risk = 0.80; 95% confidence interval, 0.70-0.91). However, among those patients receiving analgesic medications, there were no differences in likelihood of receiving an opioid, time to administration, or pain score reduction. When analyzing patients who received a surgical consult (n = 154, 4.4%), these associations were notably stronger. Surgical consult patients had a lower rate of analgesic administration (46.8%) compared with nonconsult patients (62.4%) (relative risk = 0.75; 95% confidence interval, 0.63- 0.89). Again, no differences were found in likelihood of receiving any opioid, time to administration, or pain score reduction.
  
  
  CONCLUSIONS
  Need for abdominal surgical consult is associated with decreased administration of analgesics in older patients, possibly indicating a continued need to improve management in this setting. This difference, however, did not impact pain score reductions.
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1062, New York, NY, 10029. Electronic address: Eleanor.roberts@icahn.mssm.edu.
authors.forename: Eleanor S
authors.initials: ES
authors.lastname: Roberts
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1062, New York, NY, 10029; Center for Family and Community Medicine, Columbia University Medical Center, 610 W 158th St, New York, NY, 10032.
authors.forename: Laura
authors.initials: L
authors.lastname: Belland
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1062, New York, NY, 10029.
authors.forename: Laura
authors.initials: L
authors.lastname: Rivera-Reyes
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1062, New York, NY, 10029; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Geriatrics Research, Education and Clinical Center, James J Peters VAMC, Bronx, NY.
authors.forename: Ula
authors.initials: U
authors.lastname: Hwang
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D012017:Referral and Consultation; D066231:Surgeons / Q000458:organization & administration*