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Sarangarm P, Zimmerman DE, Faine B, Rech MA, Flack T, Gilbert BW, Howington GT, Laub J, Porter B, Slocum GW, Zepeski A, Brown CS. UpdatED: The emergency medicine pharmacotherapy literature of 2022. Am J Emerg Med 2023; 69:136-142. [PMID: 37116295 DOI: 10.1016/j.ajem.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/03/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023] Open
Abstract
The purpose of this article is to summarize pharmacotherapy related emergency medicine (EM) literature indexed in 2022. Articles were selected utilizing a modified Delphi approach. The table of contents from pre-determined journals were reviewed and independently evaluated via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system by paired authors, with disagreements adjudicated by a third author. Pharmacotherapy-related publications deemed to be GRADE 1A and 1B were reviewed by the group for inclusion in the review. In all, this article summarizes and provides commentary on the potential clinical impact of 13 articles, 4 guidelines, and 3 meta-analyses covering topics including anticoagulant reversal, tenecteplase in acute ischemic stroke, guideline updates for heart failure and aortic aneurysm, magnesium in atrial fibrillation, sedation in mechanically ventilated patients and pain management strategies in the Emergency Department (ED), and tranexamic acid use in epistaxis and GI bleed.
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Affiliation(s)
- Preeyaporn Sarangarm
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM 87106, USA.
| | - David E Zimmerman
- Duquesne University School of Pharmacy, University of Pittsburgh Medical Center-Mercy Hospital, Room 311 Bayer Learning Center, 600 Forbes Avenue, Pittsburgh, PA 15282, USA
| | - Brett Faine
- Department of Emergency Medicine and Pharmacy Practice, University of Iowa, Iowa City, IA 52242, United States of America
| | - Megan A Rech
- Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Department of Emergency Medicine, S 1st Ave, Maywood 60153, IL, USA; Loyola University Medical Center, Department of Pharmacy, S 1st Ave, Maywood, IL 60153, USA
| | - Tara Flack
- Department of Pharmacy, IU Health Methodist Hospital, Indianapolis, IN 46202, USA
| | - Brian W Gilbert
- Department of Pharmacy, Wesley Medical Center, Wichita, KS 67205, USA
| | - Gavin T Howington
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40506, USA; Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY 40536, USA
| | - Jessica Laub
- Department of Pharmacy, New York-Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - Blake Porter
- Department of Pharmacy, University of Vermont Medical Center, Burlington, VT 05401, USA
| | - Giles W Slocum
- Department of Emergency Medicine and Department of Pharmacy, Rush University Medical Center, Chicago, IL 60612, USA
| | - Anne Zepeski
- Department of Emergency Medicine and Pharmacy Practice, University of Iowa, Iowa City, IA 52242, United States of America
| | - Caitlin S Brown
- Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Daoust R, Paquet J, Cournoyer A, Piette É, Morris J, Lessard J, Castonguay V, Lavigne G, Huard V, Chauny JM. Opioid and non-opioid pain relief after an emergency department acute pain visit. CAN J EMERG MED 2021; 23:342-350. [PMID: 33959920 DOI: 10.1007/s43678-020-00041-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Treatment of acute pain after emergency department (ED) discharge remains a challenge in the opioid crisis context. Our objective was to determine the proportion of patients using opioid vs non-opioid pain medication following discharge from the ED with acute pain, and the association of type of pain medication with average pain intensity before pain medication intake and report of pain relief. METHODS This was a prospective cohort study of ED patients aged ≥ 18 years with an acute pain (≤ 2 weeks) who were discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level before each pain medication intake (0-10 numeric rating scale), type of pain medication use (opioid vs non-opioid), and if pain was relieved by the medication used that day. Multilevel analyses were used to compare the effect of type of analgesic used on pain intensity and relief. RESULTS A total of 381 participants completed the 14-day diary; 50% were women and median age was 54 years (IQR = 43-66). Average daily pain intensity before pain medication intake was significantly higher for patients who used opioids (5.9; 95% CI 5.7-6.2) as compared to non-opioid analgesics (4.2; 95% CI 4.0-4.5) or no pain medication (2.2; 95% CI 1.9-2.5). Controlling for pain intensity, patients using opioids were more likely to report a pain relief (OR = 1.3; 95% CI 1.1-1.8) as compared to those who used non-opioid analgesics. CONCLUSION Overall, opioids appear to be effective and used as intended by the prescribing physician.
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Affiliation(s)
- Raoul Daoust
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada. .,Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
| | - Jean Paquet
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada
| | - Alexis Cournoyer
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada.,Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Éric Piette
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada.,Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Judy Morris
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada.,Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Justine Lessard
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada.,Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Véronique Castonguay
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada.,Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Gilles Lavigne
- Faculties of Dental Medicine and Medicine, Université de Montréal, Montréal, QC, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
| | - Vérilibe Huard
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada.,Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Jean-Marc Chauny
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada.,Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
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A Quality Improvement Initiative Featuring Peer-Comparison Prescribing Feedback Reduces Emergency Department Opioid Prescribing. Jt Comm J Qual Patient Saf 2019; 45:669-679. [PMID: 31488343 DOI: 10.1016/j.jcjq.2019.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Opioid prescribing in the United States nearly tripled from 1999 to 2015, and opioid overdose deaths doubled in the same time frame. Emergency departments (EDs) may play a pivotal role in the opioid epidemic as a source of first-time opioid exposure; however, many prescribers are generally unaware of their prescribing behaviors relative to their peers. METHODS All 117 ED prescribers at an urban academic medical center were provided with regular feedback on individual rates of opioid prescribing relative to their de-identified peers. To evaluate the effect of this intervention on the departmental rate of opioid prescribing, a statistical process control (SPC) chart was created to identify special cause variation, and an interrupted time series analysis was conducted to evaluate the immediate effect of the intervention and any change in the postintervention trend due to the intervention. RESULTS The aggregate opioid prescribing rate in the preintervention period was 8.6% (95% confidence interval [CI]: 8.3%-8.9%), while the aggregate postintervention prescribing rate was 5.8% (95% CI: 5.5%-6.1%). The SPC chart revealed special cause variation in both the pre- and postintervention periods, with an overall downtrend of opioid prescribing rates across the evaluation period and flattening of rates in the final four blocks. Interrupted time series analysis demonstrated a significant immediate downward effect of the intervention and a nonsignificant additional decrease in postintervention trend. CONCLUSION Implementation of peer-comparison opioid prescribing feedback was associated with a significant immediate reduction in the rate of ED discharge opioid prescribing.
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Fu S, Zhang K, Gu M, Liu Z, Sun W, Xiao M. Comparative efficacy and safety of analgesics for acute renal colic: A network meta-analysis protocol. Medicine (Baltimore) 2019; 98:e14709. [PMID: 30855462 PMCID: PMC6417635 DOI: 10.1097/md.0000000000014709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Acute renal colic is one of the most common urological emergencies. While previous randomized controlled trials (RCTs) and pairwise meta-analyses only looked at the efficacy of 1 or 2 analgesics. It is not fully understood that the comprehensive ranking of the effectiveness and safeness of analgesics from these published articles. Therefore, this network meta-analysis (NMA) aims to compare and rank the different analgesics for treatment of acute renal colic. METHODS AND ANALYSIS We will perform a systematic literature search in PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library to identify RCTs of different analgesics for acute renal colic. RCTs assessing active analgesics intervention against active comparator or placebo controls for acute renal colic will be included. We will also screen the reference lists of included studies, previous reviews and meta-analyses to identify other relevant trials. The primary outcomes will be pain variance at 30 minutes, need rescue medicine, complete pain relief or at least 50% pain relief at 30 minutes, and pain relapse within 24 hours. We will also assess secondary outcomes for safeness (side effects: dizziness, vomit, allergic, hypotension, cardiac toxicity, and drug dependence). The risk of bias of included RCTs will be assessed by using the Cochrane Collaboration's tool, and the quality of evidence will be assessed by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. We will perform pairwise meta-analysis and Bayesian NMA to compare the effectiveness and safeness of different analgesic interventions. RESULTS This NMA will compare and rank the different analgesics for treatment of acute renal colic. CONCLUSION This is the first systematic review to use the NMA to comprehensively compare and rank analgesics for relieving pain of acute renal colic in adults based on most important factors deciding the choice of initial analgesia, and the results can provide implications for clinical practice and further research.
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Affiliation(s)
| | | | | | | | | | - Mingzhao Xiao
- Department of Urinary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bouida W, Beltaief K, Msolli MA, Ben Marzouk M, Boubaker H, Grissa MH, Zorgati A, Methamem M, Boukef R, Belguith A, Nouira S. Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain. Pain Pract 2019; 19:275-282. [PMID: 30303612 DOI: 10.1111/papr.12736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effect on opioid requirement of pain treatment starting at triage, and to evaluate satisfaction in emergency department (ED) patients with acute pain. METHODS This is a single-blind, randomized, prospective study conducted in the ED. The included patients were randomly assigned to single oral doses of placebo, acetaminophen, or a tramadol/acetaminophen combination. Protocol treatment was given at triage. The primary outcome was the need for rescue morphine during ED stay. The secondary outcome included patient satisfaction, ED length of stay, and percentage of patients discharged from the ED with a VAS score of <30. RESULTS We included 1,485 patients: 496 patients in the placebo group, 497 in the acetaminophen group, and 492 in the tramadol/acetaminophen combination group. The groups were similar regarding demographic and clinical characteristics and baseline VAS pain scores. Rescue morphine was significantly decreased in the tramadol/acetaminophen combination group compared to that in the placebo and acetaminophen groups (11.5%, 23.2%, and 18.9%, respectively; P = 0.03). Patient satisfaction was higher in the tramadol/acetaminophen combination group (77% vs. 69% in the acetaminophen group and 68% in the placebo group). A VAS score of <30 was observed in 84% of patients in the placebo group, 83% in the acetaminophen group, and 87% in the tramadol/acetaminophen combination group (P = 0.01 between the acetaminophen group and tramadol/acetaminophen combination group). The ED length of stay was 60 minutes for the acetaminophen group and tramadol/acetaminophen combination group and 71 minutes for the placebo group (P = 0.04). CONCLUSION Oral tramadol/acetaminophen combination administered early in triage was associated with a decrease in intravenous morphine requirement and increase in satisfaction among ED patients with acute pain when compared with patients taking acetaminophen. No significant increase in side effects was found. This intervention may be considered in EDs with an aim of similar benefits.
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Affiliation(s)
- Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Maryem Ben Marzouk
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Mehdi Methamem
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Asma Belguith
- Department of Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
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Randomized Controlled Trial of Intravenous Acetaminophen Versus Intravenous Hydromorphone for the Treatment of Acute Pain in the Emergency Department. Ann Emerg Med 2019; 73:133-140. [DOI: 10.1016/j.annemergmed.2018.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022]
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Sin B, Ciaramella C, Stein G, Butel S, Thompson H, de Souza S, DiGregorio R. Implementation of an Advanced Pharmacy Practice Model in the Emergency Department. J Pharm Pract 2019; 33:481-490. [PMID: 30636511 DOI: 10.1177/0897190018819412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE The objective of this retrospective descriptive study was to quantify clinical activities performed by pharmacists in an advanced pharmacy practice model in the emergency department (ED). METHODS Data from January 2015 to August 2017 extracted from the department of pharmacy's electronic documentation system and the hospital's electronic medical record were collected and reviewed. Cost savings was derived from the system with adaptation from the previous literature and had been validated by our institution's administration as an acceptable reflection of the impact for activity. RESULTS The ED pharmacy team participated in a total of 4106 clinical activities that resulted in a cumulative cost avoidance of $5 387 679. Overall, the most common clinical activities that the pharmacy team provided included pharmacotherapy consult (63.3%) and response to medical emergencies (20.7%). A total of 16 219 medication orders placed by ED clinicians were prospectively reviewed and 379 interventions were accepted by ED clinicians. Turnaround times for medication verification in median (interquartile range [IQR]) for 2015, 2016, and 2017 were 2 minutes (1-6 minutes), 3 minutes (1-6 minutes), and 2 minutes (1-5 minutes), respectively. A total of 14 peer-reviewed publications, primarily based on pharmacy practice or use of pharmacotherapy for acute pain, were published by a research program led by the ED pharmacotherapist. CONCLUSION We created and implemented an advanced practice model tailored to our institution's needs. The model maximized opportunities for pharmacists to provide direct patient care, practice at the top of their license, and encouraged the safe and effective use of medications.
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Affiliation(s)
- Billy Sin
- Mount Sinai Queens, Long Island City, NY, USA
| | - Christine Ciaramella
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Greg Stein
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Shalom Butel
- Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Holly Thompson
- Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sylvie de Souza
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA.,Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Robert DiGregorio
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA.,Department of Clinical Affairs, Arnold & Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
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Comparison of IV dexketoprofen trometamol, fentanyl, and paracetamol in the treatment of renal colic in the ED: A randomized controlled trial. Am J Emerg Med 2017; 36:571-576. [PMID: 29029797 DOI: 10.1016/j.ajem.2017.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE In this study, we aimed to compare the analgesic efficacy of intravenous dexketoprofen trometamol, fentanyl, and paracetamol in patients presenting to the emergency department with renal colic. MATERIALS AND METHOD Data obtained from the emergency departments of Gaziantep University's Hospital for Research and Practice along with two other state hospitals in Gaziantep, Turkey between January 2016 and January 2017 was used for this study. A total of three hundred patients (n=300), who presented to the ER with complaints most common to renal colic whose diagnoses were subsequently confirmed with Computerized Tomography were included in the study. Patients' pain scores were recorded using the Visual Analogue Scale, at admission (immediately before drug administration), then at the 15th, and 30th minutes. SPSS 22.0 software package was used for analysis. p<0.05 was considered significant. RESULTS At the 15th minute comparison, the efficacies of the three groups of drugs were not superior to one other, but at the 30th minute, dexketoprofen trometamol was statistically more effective than paracetamol and fentanyl. There was no statistically significant difference between fentanyl and paracetamol. The need for additional analgesia in the group receiving dexketoprofen trometamol was found to be lower. Dexketoprofen trometamol was statistically superior to the other two agents in achieving full analgesia at the end of the thirty-minute period. Fentanyl was found to be statistically significant in achieving moderate analgesia. CONCLUSION As a Non-steroidal antiinflammatory drug dexketoprofen trometamol is superior to paracetamol and fentanyl in achieving analgesia and reducing the need for additional drugs for the treatment of renal colic.
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