34
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Impact of age, sex and route of administration on adverse events after opioid treatment in the emergency department: A retrospective study

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Opioids are an important avenue for the treatment of pain among individuals presenting to the emergency department. Unfortunately, opioid administration can lead to several complications including nausea/vomiting, oxygen desaturation and hypotension. The authors aimed to determine the incidence of such adverse events among 31,742 patients who were treated with opioids in the emergency department of a single large tertiary care hospital in Montreal, Quebec.

          Abstract

          BACKGROUND:

          The efficacy of opioids for acute pain relief in the emergency department (ED) is well recognized, but treatment with opioids is associated with adverse events ranging from minor discomforts to life-threatening events.

          OBJECTIVE:

          To assess the impact of age, sex and route of administration on the incidence of adverse events due to opioid administration in the ED.

          METHODS:

          Real-time archived data were analyzed retrospectively in a tertiary care urban hospital. All consecutive patients (≥16 years of age) who were assigned to an ED bed and received an opioid between March 2008 and December 2012 were included. Adverse events were defined as: nausea/vomiting (minor); systolic blood pressure (SBP) <90 mmHg, oxygen saturation (Sat) <92% and respiration rate <10 breaths/min (major) within 2 h of the first opioid doses.

          RESULTS:

          In the study period, 31,742 patients were treated with opioids. The mean (± SD) age was 55.8±20.5 years, and 53% were female. The overall incidence of adverse events was 12.0% (95% CI 11.6% to 12.4%): 5.9% (95% CI 5.6% to 6.2%) experienced nausea/vomiting, 2.4% (95% CI 2.2% to 2.6%) SBP <90 mmHg, 4.7% (95% CI 4.5% to 4.9%) Sat that dropped to <92% and 0.09% respiration rate <10 breaths/min. After controlling for confounding factors, these adverse events were associated with: female sex (more nausea/vomiting, more SBP <90 mmHg, less Sat <92%); age ≥65 years (less nausea/vomiting, more SBP <90 mmHg, more Sat <92%); and route of administration (intravenous > subcutaneous > oral).

          CONCLUSIONS:

          The incidence of adverse events associated with opioid administration in the ED is generally low and is associated with age, sex and route of administration.

          Translated abstract

          HISTORIQUE :

          L’efficacité des opioïdes pour soulager la douleur aiguë à la salle d’urgence ne fait aucun doute, mais elle s’associe à des effets indésirables oscillant entre des malaises mineurs et des problèmes potentiellement mortel.

          OBJECTIF :

          Évaluer les effets de l’âge, du sexe et de la voie d’administration sur l’incidence des effets indésirables causées par les opioïdes à l’urgence.

          MÉTHODOLOGIE :

          Les chercheurs ont procédé à l’analyse rétrospective des données archivées en temps réel dans un hôpital de soins tertiaires en milieu urbain. Tous les patients consécutifs (16 ans ou plus) sur civière à l’urgence et qui ont reçu un opioïde entre mars 2008 et décembre 2012 en faisaient partie. Les effets indésirables étaient définies comme des nausées ou des vomissements (mineure), une tension artérielle systolique (TAS) inférieure à 90 mmHg, une saturation en oxygène (Sat) inférieure à 92 % et une fréquence respiratoire inférieure à dix respirations à la minute (majeure) dans les deux heures suivant les premières doses d’opioïdes.

          RÉSULTATS :

          Pendant la période de l’étude, 31 742 patients ont reçu des opioïdes. Ils avaient un âge moyen (± ÉT) de 55,8±20,5 ans et 53 % étaient des femmes. L’incidence globale de effets indésirables était de 12,0 % (95 % IC 11,6 % à 12,4 %). Ainsi, 5,9 % (95 % IC 5,6 % à 6,2 %) ont souffert de nausées et de vomissements, 2,4 % (95 % IC 2,2 % à 2,6 %) d’une TAS inférieure à 90 mmHg, 4,7 % (95 % IC 4,5 % à 4,9 %) d’une Sat qui avait chuté à moins de 92 % et 0,09 % d’une fréquence respiratoire inférieure à dix respirations à la minute. Après contrôle des facteurs de confusion, ces effets indésirables s’associaient au sexe féminin (plus de nausées et de vomissements, plus de TAS < 90 mmHg, moins de Sat < 92 %), à un âge de 65 ans ou plus (moins de nausées et de vomissements, plus de TAS < 90 mmHg, plus de Sat < 92 %) et à la voie d’administration (voie intraveineuse > voie sous-cutanée > voie orale).

          CONCLUSIONS :

          L’incidence de effets indésirables associées aux opioïdes à l’urgence est généralement faible et s’associe à l’âge, au sexe et à la voie d’administration.

          Related collections

          Most cited references22

          • Record: found
          • Abstract: found
          • Article: not found

          Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies.

          To estimate the incidence of serious and fatal adverse drug reactions (ADR) in hospital patients. Four electronic databases were searched from 1966 to 1996. Of 153, we selected 39 prospective studies from US hospitals. Data extracted independently by 2 investigators were analyzed by a random-effects model. To obtain the overall incidence of ADRs in hospitalized patients, we combined the incidence of ADRs occurring while in the hospital plus the incidence of ADRs causing admission to hospital. We excluded errors in drug administration, noncompliance, overdose, drug abuse, therapeutic failures, and possible ADRs. Serious ADRs were defined as those that required hospitalization, were permanently disabling, or resulted in death. The overall incidence of serious ADRs was 6.7% (95% confidence interval [CI], 5.2%-8.2%) and of fatal ADRs was 0.32% (95% CI, 0.23%-0.41%) of hospitalized patients. We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious ADRs and 106000 (76000-137000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death. The incidence of serious and fatal ADRs in US hospitals was found to be extremely high. While our results must be viewed with circumspection because of heterogeneity among studies and small biases in the samples, these data nevertheless suggest that ADRs represent an important clinical issue.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Adverse events associated with postoperative opioid analgesia: a systematic review.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Side effects of opioids during short-term administration: effect of age, gender, and race.

              Little is known about risk factors that increase the risk of development of opioid side effects. Our objective was to evaluate the effect of the type of opioid, age, gender, and race on the incidence of side effects from short-term opioid use. A secondary analysis of a retrospective cohort study in 35 community-based and tertiary hospitals was done. There were 8855 black or white subjects aged 16 years and older. Patients received meperidine (INN, pethidine), morphine, or fentanyl as part of their treatment. Measurements were made to assess the presence of nausea and vomiting and respiratory depression. Of the patients, 26% had nausea and vomiting and 1.5% had respiratory depression after opioid administration. After adjustment for opioid dose, route of administration, age, gender, and race, meperidine produced less nausea and vomiting (odds ratio [OR] = 0.7; 95% confidence interval [CI], 0.5-0.8) and less respiratory depression (OR = 0.6; 95% CI, 0.2-0.9) than morphine. The risk of respiratory depression increased with age. Compared with patients aged between 16 and 45 years, those aged between 61 and 70 years had 2.8 times the risk of development of respiratory depression (95% CI, 1.2-6.6); those aged between 71 and 80 years had 5.4 times the risk (95% CI, 2.4-11.8); and those aged older than 80 years had 8.7 times the risk (95% CI, 3.8-20.0). Men had less nausea and vomiting than women (OR = 0.5; 95% CI, 0.4-0.6). White subjects had more nausea and vomiting than black subjects (OR = 1.4; 95% CI, 1.1-1.7). Meperidine produced fewer side effects than morphine during short-term use. The risk of respiratory depression increases substantially after 60 years of age. Women have nausea and vomiting more often than men. The effect of race deserves further investigation.
                Bookmark

                Author and article information

                Journal
                Pain Res Manag
                Pain Res Manag
                PGI
                Pain Research & Management : The Journal of the Canadian Pain Society
                Pulsus Group Inc
                1203-6765
                1918-1523
                Jan-Feb 2015
                : 20
                : 1
                : 23-28
                Affiliations
                [1 ]Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal;
                [2 ]Faculty of Medicine, Université de Montréal;
                [3 ]Centre for Advanced Research in Sleep Medicine and Department of Surgery, Hôpital du Sacré-Coeur de Montréal;
                [4 ]Faculties of Dental Medicine and Medicine, Université de Montréal; Montréal, Québec
                Author notes
                Correspondence: Dr Raoul Daoust, Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, Montréal, Québec H4J 1C5. Telephone 514-338-2222 ext 3360, fax 514-338-3513, e-mail raoul.daoust@ 123456videotron.ca
                Article
                prm-20-23
                10.1155/2015/316275
                4325886
                25664538
                36e85638-e9c6-457b-b6cc-f1698accd9aa
                © 2015, Pulsus Group Inc. All rights reserved

                This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) ( http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact support@ 123456pulsus.com

                History
                Categories
                Original Article

                adverse events,age effect,emergency department,sex,opioid
                adverse events, age effect, emergency department, sex, opioid

                Comments

                Comment on this article