Association Between Inadequate Pain Control and Emergency Department Utilization in Trauma Patients

Up to 20% of trauma patients return to the emergency department (ED) within 30 d, most commonly for pain. The association between inpatient opioids, discharge prescriptions, and ED visits has not been studied.

This is a single-institution, retrospective nested case-control study of adult trauma patients admitted to an urban level I trauma center, 2018-2021, with an opioid requirement at discharge. Multivariable logistic regression was used to determine the association between discharge opioid prescriptions, days of pain control prescribed based on individual patient needs, and ED visits for pain.

Of 1569 patients, 1173 (74.76%) were prescribed opioids at discharge, and 167 (10.64%) had an ED visit for pain. Those discharged with an opioid prescription had lower odds of ED visits for pain (odds ratio 0.66, 95% confidence interval 0.44-0.99, P = 0.04). The median days of pain control prescribed at discharge was 0.61 (interquartile range 0-2.22) for those with an ED visit, compared to 1.5 (interquartile range 0.10-3.75) for those without. However, discharge with greater pain control days was not significantly associated the odds of ED visits for uncontrolled pain (odds ratio 0.96, 95% confidence interval 0.91-1.02, P = 0.19).

Among patients requiring opioids at discharge, lack of discharge opioid prescriptions is associated with increased odds of ED visits for pain. For those patients who are prescribed opioids, quantity is not significant, indicating that a conservative approach may be appropriate. Providers should consider careful analysis of inpatient pain control prescriptions, appropriate tapers, and ensure commensurate prescriptions at discharge to optimize pain management and potentially reduce preventable ED visits.