title: Predicting morphine related side effects in the ED: An international cohort study.
abstract: OBJECTIVE
  Morphine is the reference treatment for severe acute pain in an emergency department. The purpose of this study was to describe and analyse opioid-related ADRs (adverse drug reactions) in a large cohort of emergency department patients, and to identify predictive factors for those ADRs.
  
  
  METHODS
  In this prospective, observational, pharmaco-epidemiological international cohort study, all patients aged 18years or older who were treated with morphine were enrolled. The study was done in 23 emergency departments in the US and France. Baseline numerical rating scale score and initial and total doses of morphine titration were recorded. Logistic regression analysis was used to study the effects of demographic, clinical and medical history covariates on the occurrence of opioid-induced ADRs within 6h after treatment.
  
  
  RESULTS
  A total of 1128 patients were included over 10months. Median baseline initial pain scores were 8/10 (7-10) versus 3/10 (1-4) after morphine administration. Median titration duration was 10min (IQR, 1-30). The occurrence of opioid-induced ADRs was 25% and 2% were serious. Patients experienced mainly nausea and drowsiness. Medical history of travel sickness (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.01-2.86) and history of nausea or vomiting post morphine (OR, 3.86; 95% CI, 2.29-6.51) were independent predictors of morphine related ADRs.
  
  
  CONCLUSIONS
  Serious morphine related ADRs are rare and unpredictable. Prophylactic antiemetic therapy could be proposed to patients with history of travel sickness and history of nausea or vomiting in a postoperative setting or after morphine administration.
authors.affiliation: Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059 Cedex 9, France; INSERM UMR 1027, Université Paul Sabatier, Toulouse 31000, France. Electronic address: bounes.v@chu-toulouse.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bounes
authors.affiliation: Service d'Accueil des Urgences (SAMU 47), Centre Hospitalier d'Agen, Agen 47923, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Charriton-Dadone
authors.affiliation: Pôle Médecine d'Urgence, Hôpital Universitaire de Nice, Nice 06000, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Levraut
authors.affiliation: Service d'Accueil des Urgences, Centre Hospitalier de Dunkerque, Dunkerque 59385, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Delangue
authors.affiliation: Pôle Urgences Médecine Aigüe, Hôpital Universitaire des Alpes, Grenoble 38043 Cedex 9, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Carpentier
authors.affiliation: Pôle Médecine d'Urgence, Centre Hospitalier Comminges Pyrénées, Saint-Gaudens 31806, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Mary-Chalon
authors.affiliation: Pôle Médecine d'Urgence, Hôpitaux Universitaires de Toulouse, Toulouse 31059 Cedex 9, France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Houze-Cerfon
authors.affiliation: Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmaco-épidémiologie et d'Informations sur e médicament, Hôpital Universitaire de Toulouse, Toulouse 31059 Cedex 9, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Sommet
authors.affiliation: Pôle Médecine d'Urgence, Hôpitaux Universitaires de Toulouse, Toulouse 31059 Cedex 9, France.
authors.forename: Charles-Henri
authors.initials: CH
authors.lastname: Houze-Cerfon
authors.affiliation: Department of Emergency Medicine Administrative Offices, West CC-2, Beth Israel Deaconess Medical Center, 1 Deaconess Place, Boston, MA 02215, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ganetsky
mesh_terms: D059787:Acute Pain / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D017109:Akathisia, Drug-Induced / Q000453:epidemiology / Q000209:etiology*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects*; D009041:Motion Sickness / Q000453:epidemiology; D015999:Multivariate Analysis; D009325:Nausea / Q000139:chemically induced* / Q000453:epidemiology; D016017:Odds Ratio; D017891:Pharmacoepidemiology; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced* / Q000453:epidemiology; D012307:Risk Factors; D012894:Sleep Stages; D014481:United States / Q000453:epidemiology; D014839:Vomiting / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Analgesia; Emergency department; Morphine; Side effects