The following is a summary of “Factors that affect pain management in adults diagnosed with acute appendicitis in the emergency department: A retrospective study,” published in the September 2023 issue of Emergency Medicine by Weiss, et al.

The administration of analgesic treatment, including opioids, to patients with suspected appendicitis is a common practice in emergency departments (EDs). For a study, researchers sought to explore the factors influencing pain treatment decisions in adult patients with appendicitis in the ED and assess whether administering analgesia affects clinical outcomes.

The retrospective study analyzed the medical records of adult patients diagnosed with appendicitis at discharge from a single-center hospital. Patients were grouped based on the type of analgesia they received during their ED visit. The study examined various factors, including the day of presentation, gender, age, triage pain scale score, time to ED discharge, imaging procedures, surgical interventions, and hospital stay duration. The analysis employed univariable and multivariable logistic regression models to identify the factors influencing treatment choices and their impact on clinical outcomes.

The study analyzed the medical records of 1,839 patients with a discharge diagnosis of appendicitis. The patients were categorized into three groups based on their analgesia treatment in the emergency department (ED): 883 patients (48%) did not receive any form of analgesia, 571 patients (31%) were exclusively administered non-opioid medications, and 385 patients (21%) received at least one opioid. Notably, Patients with a higher triage pain level were significantly more likely to receive analgesia (4–6: OR = 1.85; 95% CI = 1.2–2.84, 7–9: OR = 3.36; 95% CI = 2.18–5.17, 10: OR = 10.78; 95% CI = 6.38–18.23) and at least one opioid (4–6: OR = 2.88; 95% CI = 1.13–7.34, 7–9: OR = 4.36; 95% CI = 1.73–11.01, 10: OR = 6.23; 95% CI = 2.42–16.09).  Male patients had a lower likelihood of receiving analgesia (OR = 0.74; 95% CI = 0.61–0.9) but were more likely to receive opioids if they received any pain medication (OR = 1.87; 95% CI = 1.41–2.48). Patients aged 25–64 years were more likely to receive opioids if they received any pain medication (25–44: OR = 1.47; 95% CI = 1.08–2.02, 45–64: OR = 1.78; 95% CI = 1.15–2.76). Sunday presentations were associated with lower rates of opioid treatment (OR = 0.63; 95% CI = 0.42–0.94). Regarding clinical outcomes, patients who received analgesia experienced extended wait times for imaging procedures (mean difference: +0.58 hours; 95% CI = 0.31–0.85). Longer ED stays (mean difference: +2.2 hours; 95% CI = 1.60–2.79) and slightly protracted hospitalization durations (mean difference: +0.62 days; 95% CI = 0.34–0.90).

Nearly half of the patients diagnosed with appendicitis did not receive any analgesic treatment, and among those treated, non-opioid medications were more commonly prescribed than opioids. Age and day of presentation (specifically, Sundays) influenced opioid administration. Patients who received analgesia had prolonged wait times for imaging; extended ED stays, and slightly lengthier hospitalizations.

Source: sciencedirect.com/science/article/abs/pii/S0735675723002887