Takeaway
- For patients presenting to emergency department (ED) with headache, an opioid-free treatment algorithm was associated with fewer revisits within 30 days.
- The difference was small.
- Other beneficial outcomes were noted with opioid-free treatment.
Why this matters
- In ED, opioids are often used against recommendations to treat headache, which correlates with multiple worse outcomes.
Key results
- After algorithm, opioid administration decreased by 11.3%.
- Primary outcome, post- vs prealgorithm groups:
- 6.3% (84/1339) vs 8.2% (133/1614); absolute difference, 1.9%.
- OR, 0.75 (95% CI, 0.56-0.99; P=.049).
- Also lower in postalgorithm group: ED revisits across entire study period, number of patients treated in ED with opioids, number receiving discharge opioid prescriptions.
- Comparing patient encounters involving ED opioids vs not (n=335 and 2618, respectively), lower 30-day ED revisit rate, fewer ED revisits across entire study period, lower admission rate, and shorter ED lengths of stay.
- Similar with- vs without-opioids changes in pain scores.
Study design
- Retrospective multi-ED chart review of patient encounters 4 months before and 5 months after implementation of opioid-free treatment algorithm for headache or migraine (n=2953).
- Outcome: returns to ED for headache or migraine within 30 days.
- Funding: None.
Limitations
- Causation not demonstrated.
- Potential confounding.
References
References
