Analgesic use in emergency department patients with abdominal pain

Study objectives: The objective of this study is to examine emergency department (ED) treatment of patients who present with the complaint of abdominal pain.

Methods: Data analyzed in this study were from the 1999 and 2000 National Hospital Ambulatory Medical Care Surveys. Patient selection was based on 18 International Classification of Diseases, Ninth Revision, Clinical Modification codes related to complaints of abdominal pain.

Results: From the 3,785 patients analyzed, abdominal pain and associated disorders represented an estimated 17 million, or 8%, of US ED visits. In this group, 62% were women, 75% were white, and the mean age was 37±24 years. The most common final diagnoses were nonspecific abdominal pain (49%), gastroenteritis (22%), and gastritis or duodenitis (11%). Patient pain severity was reported as mild in 31%, moderate in 39%, and severe in 17% of cases. Overall, pain medication was administered to 37% of patients, with 53% of pain medications being given orally. Narcotics were given to 22% and nonnarcotics were administered to 16% of patients. The most frequently administered medications were promethazine (15%), meperidine (9%), and acetaminophen (8%). Patients presenting with moderate or severe pain were 53% more likely to receive a pain medication (49% versus 32%, adjusted odds ratio [OR]=1.8, P<.01), 89% more likely to receive a narcotic (34% versus 18%, adjusted OR=1.4, P<.01), and 29% more likely to receive a parenteral medication (49% versus 38%, adjusted OR=1.4, P<.01). Patients receiving a parenteral narcotic were 2.1 times more likely to be admitted (40% versus 19%, adjusted OR=5.2, P<.01).

Conclusion: The majority of abdominal pain patients treated in the ED do not receive any medication for pain relief. Patients presenting with severe or moderate pain are more likely to receive a pain medication, often a parenteral narcotic, and are more likely to be admitted for their abdominal pain.

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