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Variations of pain medication use for patients with acute extremity pain in an emergency department: A quality improvement project

Rachael M. Cardinal, PharmD, Frank D’Amico, PhD, Elizabeth Cassidy, PharmD, Richard Heath, MD, Megan Baumgartner, PharmD


Objective: The opioid epidemic continues to take over 50,000 lives annually. At least 75 percent of patients present to an emergency department (ED) for pain. The objective of this study is to describe the characteristic(s) for receiving opioid, nonopioid, and combination analgesics in an ED for acute extremity pain.

Methods: A single-site, retrospective chart audit was conducted at a community-based teaching hospital. Patients 18 years old who were discharged from the ED with acute extremity pain and received at least one analgesic were included. Primary goal included determining characteristics associated with the prescribing of analgesics. Secondary goals included amount of pain score reduction, frequency of prescribing, and discharge prescription patterns among each group. Analyses consisted of univariate and multivariate general linear models analyses.

Results: There were 878 patients identified as having acute extremity pain between February and April 2019. A total of 335 patients met inclusion criteria and were separated into three groups: nonopioids (n = 200), opioids (n = 97), and combination analgesics (n = 38). The individual characteristics showing statistical differences (p < 0.05) between the groups were (1) an allergy to specific analgesics, (2) diastolic blood pressure > 90 mmHg, (3) heart rate > 100 bpm, (4) opioid use prior to ED admission, (5) prescriber level, and (6) discharge diagnosis. Multivariate analyses showed combination therapy (regardless of which two analgesics were administered) had a significant difference in mean pain score reduction compared to nonopioids (p < 0.05).

Conclusion: There are patient, prescriber, and environment-specific characteristics that are associated with analgesic selection in an ED. Combination therapy had the greatest reduction in pain regardless of the two medications received.


opioids; nonopioids; acute extremity pain; emergency department; analgesics

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