Cessation of Driving is Rare in Older Drivers Seen in the Emergency Department After a Motor Vehicle Collision: A Prospective Cohort Study

Richmond, Natalie L.; Flannigan, Sean A.; Keil, Lukas G.; Betz, Marian E.; Platts‐Mills, Timothy F.

doi:10.1111/jgs.13223

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…A sample size of 30 patients in each tertile of SDM to be used in an analysis of variance (ANOVA) was needed to identify a 2‐point difference in change in pain severity with a power of 0.80 and alpha of 0.05 assuming a standard deviation for change in pain severity of 2.5 points. The standard deviation estimate was based on the observed standard deviation for change in pain scores in an ongoing prospective observational study of older adults presenting to the emergency department after motor vehicle collision; the methods of this study have been described previously . This power calculation was done a priori.…”

Section: Methodsmentioning

confidence: 99%

A Prospective Evaluation of Shared Decision‐making Regarding Analgesics Selection for Older Emergency Department Patients With Acute Musculoskeletal Pain

Holland

Hunold

Mangipudi

et al. 2016

Academic Emergency Medicine

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Objectives Musculoskeletal pain is a common reason for emergency department (ED) visit by older adults. Outpatient pain management following ED visits in this population is challenging as a result of contraindications to, and side effects from, available therapies. Shared decision-making (SDM) between patients and emergency physicians may improve patient experiences and health outcomes. Among older ED patients with acute musculoskeletal pain, we sought to characterize their desire for involvement in the selection of outpatient analgesics. We also sought to assess the impact of SDM on change in pain at 1 week, patient satisfaction, and side effects. Methods This was a prospective study of adults aged 60 years and older presenting to the ED with acute musculoskeletal pain. Participants’ desire to contribute to outpatient analgesic selection was assessed by phone within 24 hours of ED discharge using the Control Preferences Scale and categorized as active, collaborative, or passive. The extent to which SDM occurred in the ED was also assessed within 24 hours of discharge using the 9-item Shared Decision Making Questionnaire, and scores were subsequently grouped into tertiles of low, middle, and high SDM. The primary outcome was change in pain severity between the ED visit and 1 week. Secondary outcomes included satisfaction regarding the decision about how to treat pain at home, satisfaction with the pain medication itself, and side effects. Results Desire of participants (N = 94) to contribute to the decision regarding selection of outpatient analgesics varied: 16% active (i.e., make the final decision themselves), 37% collaborative (i.e., share decision with provider), and 47% passive (i.e., let the doctor make the final decision). The percentage of patients who desired an active role in the decision was higher for patients who were college educated versus those who were not college educated (28% vs. 11%; difference 17%, 95% confidence interval [CI] = 0% to 35%), received care from a nurse practitioner versus a resident or an attending physician (32% vs. 9%; difference 23%, 95% CI = 4% to 42%), or received care from a female versus a male provider (24% vs. 5%; difference 19%, 95% = CI 5% to 32%). After potential confounders were adjusted for, the mean decrease in pain severity from the ED visit to 1-week follow-up was not significantly different across tertiles of SDM (p = 0.06). Higher SDM scores were associated with greater satisfaction with the discharge pain medications (p = 0.006). SDM was not associated with the class of analgesic received. Conclusions In this sample of older adults with acute musculoskeletal pain, the reported desire of patients to contribute to decisions regarding analgesics varied based on both patient and on provider characteristics. SDM was not significantly related to pain reduction in the first week or type of pain medication received, but was associated with greater patient satisfaction.

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Section: Methodsmentioning

confidence: 99%