Pub Date : 2024-02-01DOI: 10.1016/j.jemermed.2024.02.004
Agnes Engström, A. Mokhtari, Ulf Ekelund
{"title":"Direct comparison of the European Society of Cardiology 0/1-hour versus 0/2-hour algorithms in acute chest pain patients","authors":"Agnes Engström, A. Mokhtari, Ulf Ekelund","doi":"10.1016/j.jemermed.2024.02.004","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.02.004","url":null,"abstract":"","PeriodicalId":501218,"journal":{"name":"The Journal of Emergency Medicine","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139880282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.jemermed.2024.02.008
Zhengqiu Zhou, Kevin S. Hsu, Joshua Eason, Brian Kauh, Joshua Duchesne, Mikiyas Desta, William Cranford, Alison Woodworth, James D. Moore, Seth T. Stearley, Vedant A. Gupta
{"title":"Improvement of Emergency Department Chest Pain Evaluation Using Hs-cTnT and a Risk Stratification Pathway","authors":"Zhengqiu Zhou, Kevin S. Hsu, Joshua Eason, Brian Kauh, Joshua Duchesne, Mikiyas Desta, William Cranford, Alison Woodworth, James D. Moore, Seth T. Stearley, Vedant A. Gupta","doi":"10.1016/j.jemermed.2024.02.008","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.02.008","url":null,"abstract":"","PeriodicalId":501218,"journal":{"name":"The Journal of Emergency Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139882182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.1016/j.jemermed.2023.12.002
Ben Averkamp, Katherine Li, Meghan K. Wally, Tamar Roomian, Christopher Griggs, Michael Runyon, Joseph R. Hsu, Rachel B. Seymour, Michael Beuhler, Michael J. Bosse, Manuel Castro, Michael Gibbs, Steven Jarrett, Daniel Leas, Susan Odum, Ziqing Yu, James Rachal, Animita Saha, D. Matthew Sullivan, Brad Watling
Background
Opioids are commonly prescribed for the management of acute orthopedic trauma pain, including nonoperative distal radius fractures.
Objectives
This prospective study aimed to determine if a clinical decision support intervention influenced prescribing decisions for patients with known risk factors. We sought to quantify frequency of opioid prescriptions for acute nonoperative distal radius fractures treated.
Methods
We performed a prospective study at one large healthcare system. Utilizing umbrella code S52.5, we identified all distal radius fractures treated non-operatively and the encounters were merged with Prescription Reporting with Immediate Medication Mapping (PRIMUM) database to identify encounters with opioid prescriptions and patients with risk factors for opioid use disorder. We used multivariable logistic regression to determine patient characteristics associated with the prescription of an opioid. Among encounters that triggered the PRIMUM alert, we calculated the percentage of encounters where the PRIMUM alert influenced the prescribing decision.
Results
Of 2984 encounters, 1244 (41.7%) included an opioid prescription. Age increment is a significant factor to more likely receive opioid prescriptions (p<0.0001) after adjusting for other factors. Among encounters where the physician received an alert, those that triggered the alert for early refill were more likely to influence physicians’ opioid prescribing when compared to other risk factors (p=0.0088).
Conclusion
Over 90% of patients (106/118) continued to receive an opioid medication despite having known risk factor for abuse. Additionally, we found older patients were more likely prescribed opioids for non-operatively managed distal radius fractures.
背景阿片类药物是治疗急性骨科创伤疼痛（包括非手术性桡骨远端骨折）的常用处方药。这项前瞻性研究旨在确定临床决策支持干预是否会影响已知风险因素患者的处方决策。我们试图量化急性桡骨远端骨折非手术治疗的阿片类药物处方频率。方法我们在一家大型医疗保健系统进行了一项前瞻性研究。利用总括代码 S52.5，我们确定了所有接受非手术治疗的桡骨远端骨折，并将这些病例与处方报告与即时用药映射（PRIMUM）数据库合并，以确定有阿片类药物处方的病例和有阿片类药物使用障碍风险因素的患者。我们使用多变量逻辑回归来确定与阿片类药物处方相关的患者特征。在触发 PRIMUM 警报的病例中，我们计算了 PRIMUM 警报影响处方决定的病例百分比。在对其他因素进行调整后，年龄的增加是更有可能获得阿片类药物处方的一个重要因素（p<0.0001）。结论90% 以上的患者（106/118）在已知有滥用风险因素的情况下仍继续接受阿片类药物治疗。此外，我们发现年龄较大的患者更有可能在非手术治疗桡骨远端骨折时被处方阿片类药物。
{"title":"Opioid Prescribing Rate for Non-operative Distal Radius Fractures and Clinician Response to a Clinical Decision Support Alert","authors":"Ben Averkamp, Katherine Li, Meghan K. Wally, Tamar Roomian, Christopher Griggs, Michael Runyon, Joseph R. Hsu, Rachel B. Seymour, Michael Beuhler, Michael J. Bosse, Manuel Castro, Michael Gibbs, Steven Jarrett, Daniel Leas, Susan Odum, Ziqing Yu, James Rachal, Animita Saha, D. Matthew Sullivan, Brad Watling","doi":"10.1016/j.jemermed.2023.12.002","DOIUrl":"https://doi.org/10.1016/j.jemermed.2023.12.002","url":null,"abstract":"<h3>Background</h3><p>Opioids are commonly prescribed for the management of acute orthopedic trauma pain, including nonoperative distal radius fractures.</p><h3>Objectives</h3><p>This prospective study aimed to determine if a clinical decision support intervention influenced prescribing decisions for patients with known risk factors. We sought to quantify frequency of opioid prescriptions for acute nonoperative distal radius fractures treated.</p><h3>Methods</h3><p>We performed a prospective study at one large healthcare system. Utilizing umbrella code S52.5, we identified all distal radius fractures treated non-operatively and the encounters were merged with Prescription Reporting with Immediate Medication Mapping (PRIMUM) database to identify encounters with opioid prescriptions and patients with risk factors for opioid use disorder. We used multivariable logistic regression to determine patient characteristics associated with the prescription of an opioid. Among encounters that triggered the PRIMUM alert, we calculated the percentage of encounters where the PRIMUM alert influenced the prescribing decision.</p><h3>Results</h3><p>Of 2984 encounters, 1244 (41.7%) included an opioid prescription. Age increment is a significant factor to more likely receive opioid prescriptions (p<0.0001) after adjusting for other factors. Among encounters where the physician received an alert, those that triggered the alert for early refill were more likely to influence physicians’ opioid prescribing when compared to other risk factors (p=0.0088).</p><h3>Conclusion</h3><p>Over 90% of patients (106/118) continued to receive an opioid medication despite having known risk factor for abuse. Additionally, we found older patients were more likely prescribed opioids for non-operatively managed distal radius fractures.</p>","PeriodicalId":501218,"journal":{"name":"The Journal of Emergency Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139027258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号