Medical Technology

Headache Patients Given NSAIDs 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 (ED) setting, based on data from approximately 7000 patients.

Headache is the fourth most common chief complaint in the emergency department, accounting for approximately 3% of all ED visits, said Philip Wang, a medical student at the Cleveland Clinic, Ohio, in a presentation at the American College of Emergency Physicians (ACEP) 2021 Scientific Assembly.

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 emergency department stay, Wang and colleagues reviewed data from 7233 visits by 6715 patients at any of the 21 Cleveland Clinic Health System emergency departments 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 emergency department stay was 202 minutes.

In a multivariate analysis adjusted for sex, age, income, race, insurance status, emergency department 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, 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 emergency department stay in patients presenting with headache, he concluded.

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

Ann Emerg Med. 2021;78:S10. Abstract

American College of Emergency Physicians (ACEP) 2021 Scientific Assembly: Abstract 24. Presented October 2021.

Heidi Splete is a freelance medical journalist with 20 years of experience.

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