Trends in acute pain management for renal colic in the emergency department at a tertiary care academic medical center

Link to article at PubMed

J Endourol. 2020 Jul 15. doi: 10.1089/end.2020.0402. Online ahead of print.

ABSTRACT

INTRODUCTION Renal colic secondary to kidney stone disease is a common reason for emergency department (ED) visits and often leads to patients receiving narcotic medications. The objective of this study was to describe longitudinal analgesia prescribing patterns for kidney stone patients acutely managed in the ED. METHODS This was a retrospective chart review of patients who presented to the ED between 2013 and 2018 and were subsequently diagnosed with a kidney stone. Encounters during which opioids and non-opioids were administered in the ED and prescribed at discharge were stratified by year, race, ethnicity, insurance status, gender, and location of ED (main academic campus and community-based campus). Patients were excluded if they required hospital admission or a stone related procedure related to the ED encounter. RESULTS We reviewed 1620 total encounters for 1376 unique patients. Frequency of patients receiving opioids in the ED decreased from 81% in 2013 to 57% in 2018 (p<0.001). During the same time period, non-opioid administration in the ED remained relatively unchanged (64% vs 67%). The proportion of patients prescribed opioids at discharge decreased from 77% to 59% (p<0.001), while non-opioid prescriptions at discharge increased from 32% to 41% (p = 0.010). Frequency of administering both a narcotic and non-narcotic during the same ED encounter decreased over the five-year period from 27% to 8% (p<0.001). CONCLUSION Opioids are being given less both during the ED encounter and at discharge for acute renal colic, while non-opioid prescribing is increasing. These trends may be due to increasing physician awareness to opioid addiction, or as a result of stricter legislation prohibiting opioid prescribing.

PMID:32668985 | DOI:10.1089/end.2020.0402

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