Emergency Department Opioid Analgesia in Trauma Patients Is Less Common in the More Severely Injured

BACKGROUND: Many ED physicians hesitate to use opioids in trauma patients for fear of lowering blood pressure, altering sensorium, and masking the physical exam. OBJECTIVE: To identify factors associated with ED opioid administration to trauma patients. METHODS: Design-retrospective, cohort study (record review). Setting-Urban, Level 1 trauma center. Subjects-trauma patients (1/1-12/31/99) whose prehospital findings prompted a high-level trauma team activation and who were ultimately hospitalized. Predictors-Age, sex, race, mechanism of injury, vital signs, oxygen saturation, Glasgow Coma Score (GCS), revised trauma score (RTS), and procedures. Outcome-opioid administration within 3 hours of ED arrival. Patients who only received opioids within 10 min. of procedures were excluded. Analysis - Univariate and multivariate analysis with opioid administration as the dichotomous outcome. RESULTS: Abstracted data on 540 trauma patients were included in the analysis. 258 (48%) received IV opioids. On univariate analysis, patients were significantly more likely to receive opioids if they had a fracture manipulation, a higher GCS, were not intubated, had a higher RTS, were burned, or were in a motorcycle crash. Selected multivariate odds ratios for opioid analgesia are shown below: Factor Odds Ratio 95% CI Fx/Manipulation 16.37 4.40 60.93 Intubated 0.40 0.28 0.78 RTS (incorporates GCS) 1.55 1.22 1.97 Burn 3.26 0.88 12.03 Motorcycle crash 4.16 0.71 24.56 Assault/Brawl 0.48 0.13 1.79 CONCLUSION: Too few injured patients receive opioid analgesia. Patients with obvious injuries such as burns or fractures are more likely to receive opioids. More seriously injured patients, particularly intubated patients or those with altered mentation, are less likely to receive opioid analgesia.