Conference Coverage

Patients given NSAIDs over antiemetics for headaches spend less time in the ED


 

Oral drug administration was significantly associated with a shorter length of stay for patients treated for headache in the emergency department setting, based on data from approximately 7,000 patients.

Headache is the fourth-most common chief complaint in the ED, accounting for approximately 3% of all ED visits, said Philip Wang, a medical student at the Cleveland Clinic, in a presentation at the annual meeting of the American College of Emergency Physicians.

A variety of pharmacotherapies are used to manage headache, which leads to a range of resource use, he said.

To understand the association between route of drug administration and length of ED stay, Mr. Wang and colleagues reviewed data from 7,233 visits by 6,715 patients at any of the 21 Cleveland Clinic Health System EDs in 2018 with headache as the primary discharge diagnosis. Patients admitted to the hospital were excluded; those treated with opioids, antiemetics, and/or NSAIDs were included. The average age of the study population was 31 years, 57% were White, and approximately half were Medicaid or Medicare patients.

Approximately 68% of patients received antiemetics, 66.8% received NSAIDs, and 9.8% received opioids. Approximately 42% of patients received parenteral-only treatment and 42% received oral-only treatment; 15% received mixed treatment. The average length of ED stay was 202 minutes.

In a multivariate analysis adjusted for sex, age, income, race, insurance status, ED type, and arrival time, treatment with oral drugs only was associated with an 11% reduction of length of stay, compared with treatment with parenteral medication only (P < .001). However, the length of stay for patients treated with mixed route of administration was 10% longer, compared with parenteral only (P < .001).

In terms of drug class (a secondary outcome), patients treated with opioids had a 10% increase in length of stay (P < .01) and those treated with antiemetics had a 14% increase in length of stay; however, patients treated with NSAIDs had a 7% decrease in length of stay.

The study findings were limited in part by the challenge of isolating patients presenting with a primary headache diagnosis, Mr. Wang noted in the presentation.

The challenge of controlling for all the potential factors impacting length of stay, which is “provider, resource, and situation dependent,” is an additional limitation, he said.

However, the results show that route of administration has a significant impact on length of ED stay in patients presenting with headache, he concluded.

The study received no outside funding. The researchers disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Recommended Reading

Yoga is a good adjunct to migraine therapy
Federal Practitioner
Headache may predict clinical evolution of COVID-19
Federal Practitioner
Women increasingly turn to CBD, with or without doc’s blessing
Federal Practitioner
Researchers examine factors associated with opioid use among migraineurs
Federal Practitioner
Neurologic disorders ubiquitous and rising in the U.S.
Federal Practitioner
Green light puts the stop on migraine
Federal Practitioner
Cannabis for migraine strongly linked to rebound headache
Federal Practitioner
Transcranial brain stimulation can modulate placebo and nocebo experiences
Federal Practitioner
Race, ethnicity, and socioeconomics are often barriers to migraine care
Federal Practitioner
New antimigraine drugs linked with less risk for adverse events
Federal Practitioner