The effect of surgical consult in the treatment of abdominal pain in older adults in the ED

Abstract

Objective To determine whether need for surgical consult contributes to delayed or reduced analgesic administration in older adults presenting to the ED with abdominal pain. Methods Secondary data analyses from a prospective cohort study consisting of adults ≥ 65 years in age presenting to the ED with a chief complaint of abdominal pain from 11/1/2012 through 10/31/2014. Measurements included administration of analgesics, time to administration, type given, and pain score reduction. Covariates for adjusted analyses included age, sex, race/ethnicity, and Emergency Severity Index. Results 3,522 patients were included, of which 281 (8.7%) received any consult. Consult patients were less likely to receive any analgesic medication (53.0%) compared to non-consult patients (62.5%), relative risk (RR) of 0.80 (95% CI 0.70 to 0.91). However, among those patients receiving analgesic medications, there were no differences in likelihood of receiving an opioid, time to administration, or pain score reduction. When analyzing patients who received a surgical consult (n=154, 4.4%), these associations were notably stronger. Surgical consult patients had a lower rate of analgesic administration (46.8%) compared to non-consult patients (62.4%), RR = 0.75 (95% CI 0.63 to 0.89). Again, no differences were found in likelihood of receiving any opioid, time to administration, or pain score reduction. Conclusion Need for abdominal surgical consult is associated with decreased administration of analgesics in older patients, possibly indicating a continued need to improve management in this setting. This difference, however, did not impact pain score reductions.

Assessment and management of older patients with abdominal pain in the emergency department

“…Fears that analgesia will mask severity, leading to misdiagnosis, are misplaced. Older age is a known risk factor for inadequate analgesia, with evidence showing nearly half of older people with abdominal pain receive no analgesia in the ED 11,36,37 . Improving this should be a priority.…”