Ellen Kettler1, Jesse Brennan2, Christopher J Coyne3. 1. University of California, San Diego School of Medicine, La Jolla, CA, USA; Department of Emergency Medicine, 200 W. Arbor Dr. #8676 San Diego, CA 92103, USA. Electronic address: ekettler@ucsd.edu. 2. University of California, San Diego School of Medicine, La Jolla, CA, USA; Department of Emergency Medicine, 200 W. Arbor Dr. #8676 San Diego, CA 92103, USA. Electronic address: jjbrennan@ucsd.edu. 3. University of California, San Diego School of Medicine, La Jolla, CA, USA; Department of Emergency Medicine, 200 W. Arbor Dr. #8676 San Diego, CA 92103, USA. Electronic address: cjcoyne@ucsd.edu.
Abstract
OBJECTIVE: In 2018, due to a national morphine shortage, our two study emergency departments (EDs) were unable to administer intravenous (IV) morphine for over six months. We evaluated the effects of this shortage on analgesia and patient disposition. METHODS: This was a retrospective study in two academic EDs. Our control period (with morphine) was 4/1/17-6/30/17 and our study period (without morphine) was 4/1/18-6/30/18. We included all adult patients with a chief complaint of pain, initial pain score ≥4, and ≥2 recorded pain scores. The primary outcome was delta pain score. Secondary outcomes included final pain score, proportion of ED visits with opioids vs. non-opioids administered, and ED disposition. RESULTS: We identified 6296 patients during our control period and 5816 during our study period. There was no significant difference in mean final pain score (study 4.45, control 4.44, p = 0.802), delta pain score (study -3.30, control -3.32, p = 0.556), nor admission rates (study 18.8%, control 17.8%, p = 0.131). We saw a decrease in opioid use (study 47.4%, control 60.0%, p < 0.01) and an increased use of non-opioid analgesics (study 27.3%, control 18.44%, p < 0.01). CONCLUSIONS: Removing IV morphine in the ED, without a compensatory rise in alternative opioids, does not appear to significantly impact analgesia or disposition. These data favor a more limited opioid use strategy in the ED.
OBJECTIVE: In 2018, due to a national morphine shortage, our two study emergency departments (EDs) were unable to administer intravenous (IV) morphine for over six months. We evaluated the effects of this shortage on analgesia and patient disposition. METHODS: This was a retrospective study in two academic EDs. Our control period (with morphine) was 4/1/17-6/30/17 and our study period (without morphine) was 4/1/18-6/30/18. We included all adult patients with a chief complaint of pain, initial pain score ≥4, and ≥2 recorded pain scores. The primary outcome was delta pain score. Secondary outcomes included final pain score, proportion of ED visits with opioids vs. non-opioids administered, and ED disposition. RESULTS: We identified 6296 patients during our control period and 5816 during our study period. There was no significant difference in mean final pain score (study 4.45, control 4.44, p = 0.802), delta pain score (study -3.30, control -3.32, p = 0.556), nor admission rates (study 18.8%, control 17.8%, p = 0.131). We saw a decrease in opioid use (study 47.4%, control 60.0%, p < 0.01) and an increased use of non-opioid analgesics (study 27.3%, control 18.44%, p < 0.01). CONCLUSIONS: Removing IV morphine in the ED, without a compensatory rise in alternative opioids, does not appear to significantly impact analgesia or disposition. These data favor a more limited opioid use strategy in the ED.
Authors: Amanda J Deutsch; David A Gajdosik; Christine Ramdin; Collin Tebo; Maryann Mazer-Amirshahi; Erin R Fox; Josh Colorado; Lewis S Nelson; Jeanmarie Perrone Journal: J Med Toxicol Date: 2021-04-27