Opioid free treatment algorithm for ED headache management: Effect on revisit rate.
Publication/Presentation Date
1-1-2020
Abstract
BACKGROUND: The opioid epidemic is a crisis leading to over utilization of resources within emergency departments (EDs). We assessed how implementation of an opioid-free headache and migraine treatment algorithm in the ED impacted patient centered outcomes.
METHODS: This was a retrospective review of patients presenting to EDs across a health network with a primary diagnosis of headache or migraine. Two analyses were completed comparing patients presenting before and after implementation of an opioid-free treatment algorithm and patients treated with or without opioids in the ED. The primary outcome was incidence of an ED revisit within thirty days. Secondary outcomes included ED length of stay, admission rate, and incidence of revisit during the entire study period.
RESULTS: In total, 2953 patient encounters were included. Incidence of revisit within thirty days was lower in the post- (84/1339, 6.3%) versus pre-algorithm group (133/1614, 8.2%; odds ratio [OR] 0.75, 95% confidence interval [CI] 0.56-0.99; p = 0.049), as was the incidence of revisit within the entire study period (9.2% vs. 12.1%; OR 0.74, CI 0.58-0.93; p = 0.014). In the secondary analysis, patients treated with opioids had a higher incidence of revisit within thirty days (51/335, 15.2%) compared to those not treated with opioids (166/2618, 6.3%). The opioid group also had a higher incidence of admission rates and median ED length of stay.
CONCLUSIONS: Opioid use in the ED to treat patients with headaches or migraines may have several negative ramifications including increased risk of revisit, hospital admission, and increased ED length of stay.
Volume
38
Issue
1
First Page
28
Last Page
32
ISSN
1532-8171
Published In/Presented At
Miller, J., Koons, L., & Longyhore, D. (2020). Opioid free treatment algorithm for ED headache management: Effect on revisit rate. The American journal of emergency medicine, 38(1), 28–32. https://doi.org/10.1016/j.ajem.2019.03.053
Disciplines
Medicine and Health Sciences | Pharmacy and Pharmaceutical Sciences
PubMedID
31104781
Department(s)
Department of Emergency Medicine, Department of Pharmacy
Document Type
Article