Age as a risk factor for inadequate emergency department analgesia

Inadequate treatment of pain, which has been termed as "oligoanalgesia", appears to be common in a number of practice settings, including the emergency department (ED). The purpose of this study was to determine whether elderly patients with isolated long-bone fractures are less likely to receive analgesics in the ED than a similar cohort of younger patients. Consecutive adult patients (aged 20 to 50 years or older than 70 years) presenting to the ED with isolated long-bone fractures were evaluated using a retrospective cohort study design. Patient demographics, ED treatment, and disposition were analyzed (t tests, chi2) to identify significant differences between the two age groups. Analgesic use was recorded as oral or parenteral, nonnarcotic or narcotic, and low or high dose (less than or at least the equivalent of 10 mg parenteral morphine sulfate, respectively). A total of 231 patients met the inclusion criteria, of whom 109 were elderly (mean age, 80.6 +/- 7.4 years) and 122 nonelderly (mean age 33.9 +/- 8.0 years). Nonelderly patients were more likely than the elderly to receive ED pain medication (80% vs 66%, P =.02) within a shorter period of time (mean 52 min vs 74 min, P = .02), and at a higher equivalent dose (44% vs 19%, P = .002). Younger patients also tended to receive more narcotic medications (98% vs 89%, P = .03). Inadequate use of analgesics in adult ED patients with acute fractures appears to be common. A chronologic basis for variability in analgesic practice needs to be further characterized.