Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN)
| Autor: | Robert A. Swor, Christopher J. Coyne, Aveh Bastani, Jason W Wilson, Adam Klotz, Arvind Venkat, Nathan I. Shapiro, Sai Ching J. Yeung, Jeffrey M. Caterino, Cielito C. Reyes-Gibby, Matthew F. Hudson, Christopher W. Baugh, David H. Adler, Charles R. Thomas, Jason J. Bischof, Corita Grudzen, Gary H. Lyman, Juan Felipe Rico, Daniel J. Pallin, Richard J. Ryan, Daniel J. Henning, Beau Abar, Troy Madsen, Steven L. Bernstein, Danielle D. Durham |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Palliative care Pain medicine Analgesic Patient Readmission 03 medical and health sciences 0302 clinical medicine Acute care Odds Ratio Risk of mortality Humans Pain Management Medicine Prospective Studies 030212 general & internal medicine Pain Measurement Analgesics business.industry Cancer Pain Emergency department Middle Aged United States Analgesics Opioid Hospitalization Oncology 030220 oncology & carcinogenesis Emergency medicine Female Emergency Service Hospital business Cancer pain Cohort study |
| Zdroj: | Supportive Care in Cancer. 29:4543-4553 |
| ISSN: | 1433-7339 0941-4355 |
| Popis: | Many patients with cancer seek care for pain in the emergency department (ED). Prospective research on cancer pain in this setting has historically been insufficient. We conducted this study to describe the reported pain among cancer patients presenting to the ED, how pain is managed, and how pain may be associated with clinical outcomes. We conducted a multicenter cohort study on adult patients with active cancer presenting to 18 EDs in the USA. We reported pain scores, response to medication, and analgesic utilization. We estimated the associations between pain severity, medication utilization, and the following outcomes: 30-day mortality, 30-day hospital readmission, and ED disposition. The study population included 1075 participants. Those who received an opioid in the ED were more likely to be admitted to the hospital and were more likely to be readmitted within 30 days (OR 1.4 (95% CI: 1.11, 1.88) and OR 1.56 (95% CI: 1.17, 2.07)), respectively. Severe pain at ED presentation was associated with increased 30-day mortality (OR 2.30, 95% CI: 1.05, 5.02), though this risk was attenuated when adjusting for clinical factors (most notably functional status). Patients with severe pain had a higher risk of mortality, which was attenuated when correcting for clinical characteristics. Those patients who required opioid analgesics in the ED were more likely to require admission and were more at risk of 30-day hospital readmission. Future efforts should focus on these at-risk groups, who may benefit from additional services including palliative care, hospice, or home-health services. |
| Databáze: | OpenAIRE |
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