Guercio JR, Hopkins TJ, Buchheit T, Prakken SD, Kipnes JR, Guinn NR, Schroeder RA, Dombrowski KE, Jimenez MI, Aronson S. Relevance of acute and chronic pain management in the emergency department to population health: a pilot analysis. Poster presented at the American Society of Anesthesiologists 2015 Annual Conference; October 24, 2015. San Diego, CA.

BACKGROUND: Acute pain (i.e. pain lasting < 3-6 months) is present in 20-53% of patients seeking emergency medical services in the prehospital setting. Chronic pain develops in a subset of acute pain patients and has been reported to impact greater than 30% of the US population, with increasing prevalence among females, elderly, and persons of low socioeconomic status. Among patients with chronic pain, low back pain is the most prevalent primary diagnosis, affecting 8.1% of the US population. When reported by body location, chronic pain is most often described in the low back (48%), followed by knee (38%), neck (28%), shoulder (27%), leg (27%), and hip (25%). Although previous studies have addressed the question of prevalence of pain in patients presenting to the Emergency Department (ED), to our knowledge, the specific somatic locations of pain in this patient population has not been studied. The purpose of this retrospective single center database analysis was to evaluate the somatic locations of pain by DRG classification for ED visits in a quaternary academic medical institution.

METHODS: Following IRB approval, a retrospective cross-sectional analysis of patients who had at least 1 visit to the ED at DUH from June 1, 2014 to December 1, 2014 was conducted. A subset of these patients with a chief complaint of pain treated and subsequently released were identified; within this subset the total number of ED visits, age, gender, insurance status, ED arrival time, ED disposition time, ED departure time, chief complaint other than pain, means of arrival, level of acuity, and disposition were assessed. A secondary analysis was preformed to evaluate the etiology of pain diagnoses in a “high utilizer” (HU) population defined as ≥ 5 pain-related ED visits within the 6 month period.

RESULTS: In the data set, the number of patients with at least 1 ED visit for a chief complaint of pain, who were subsequently treated and released, was 6,376. This corresponds to 22.8% of all unique patients seen in the ED during this 6-month period (total of 27,968 patients), and 28.9% of the 22,049 ED patients who were treated and released during the study period. The most common DRGs associated with pain-related ED encounters included abdominal pain (28.6%), chest pain (20.3%), lower extremity pain (12.4%), and back pain (9.9%). HU with a presenting complaint of pain represented 315 out of the 6,376 pain patients (5%). When the HU population was considered independently, the most common DRGs associated with ED encounters included abdominal pain (23.2%), chest pain (18.6%), lower extremity pain (13.4%), sickle cell pain crisis (10.5%), and back pain (9.6%).

DISCUSSION: Pain is a major cause of ED utilization. In this single center quaternary institution analysis, the most common acute pain complaint among patients treated in the ED and subsequently released was abdominal pain, followed by chest pain. Low back pain is the most common chronic pain complaint for ED visits in this analysis. Sickle cell pain is an important cause of ED visits in high utilizers.

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