Electronic health record associations in patients self-reporting to be difficult to anesthetize.

Robert D Bowers, Wei Shi, Chandler Pendleton, Shareef Dabdoub, Jennifer Sukalski, Olivia C Bartholomew, Christopher T Hogden
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Abstract

Background: Patients who report to be difficult to anesthetize for dental procedures are commonly encountered. Determining their frequency and shared characteristics could improve understanding of pain management failures.

Methods: Categorical and continuous variables of 24 demographic, medical history, and dental history variables were compared in a deidentified cross-sectional study using electronic health records (EHR) of patients at the University of Iowa College of Dentistry. Individuals who self-reported to be difficult to anesthetize in their dental health history form were compared to those who reported no complications with local anesthesia. Descriptive, univariate regression, and multivariable regression statistical analyses were completed on the demographic, medical history, and dental history EHR variables.

Results: A total of 12,400 deidentified patient records met the inclusion criteria with a 11.4% (n = 1,411) prevalence of difficult to anesthetize self-reports. Eight categorical variables were found to have statistically significant (95% confidence interval [CI]) adjusted odds ratios (AOR) in the multivariable regression of difficult to anesthetize reporting patients: female gender (AOR = 1.61, 95% CI: 1.32-1.96, P < 0.001), dental fear (AOR = 3.60, 95% CI: 3.01-4.31, P < 0.001), mental health disorders (AOR = 1.21, 95% CI: 1.00-1.46, P < 0.045), problems with general anesthesia (AOR = 1.46, 95% CI: 1.11-1.89, P = 0.005), neurological/nerve disorders (AOR = 1.30, 95% CI: 1.05-1.60, P = 0.015), temporomandibular joint clicking/popping (AOR = 1.31, 95% CI: 1.08-1.60, P = 0.006), needle anxiety (AOR = 29.03, 95% CI: 23.80-35.52, P < 0.001), and history of root canal treatment (AOR 0.82, 95% CI: 0.68-0.99, P = 0.035).

Conclusion: A clinically relevant percentage of patients self-reported being difficult to anesthetize for dental procedures. The relationship between local anesthesia inadequacies and variables such as female gender, dental fear, mental health, and neurological disorders requires further investigation. The use of evidence-based local anesthesia approaches and communication practices is suggested to minimize pain experienced and subsequent fear of dental care.

电子病历与患者自我报告的麻醉困难有关。
背景:报告在牙科手术中难以麻醉的患者是常见的。确定它们的频率和共同特征可以提高对疼痛管理失败的理解。方法:利用爱荷华大学牙科学院患者的电子健康记录(EHR),在一项去识别的横断面研究中,比较了24个人口统计学、病史和牙科史变量的分类变量和连续变量。在牙齿健康史中自我报告难以麻醉的个体与报告局部麻醉无并发症的个体进行比较。对人口统计学、病史和牙病史EHR变量进行描述性、单变量回归和多变量回归统计分析。结果:共有12400例未确定的患者记录符合纳入标准,其中11.4% (n = 1411)的患者自我报告麻醉困难。8个类别变量在难麻醉报告患者的多变量回归中发现有统计学意义(95%置信区间[CI])校正优势比(AOR):女性(AOR = 1.61, 95% CI: 1.32 ~ 1.96, P < 0.001)、牙科恐惧(AOR = 3.60, 95% CI: 3.01 ~ 4.31, P < 0.001)、精神健康障碍(AOR = 1.21, 95% CI: 1.00 ~ 1.46, P < 0.045)、全麻问题(AOR = 1.46, 95% CI:1.11-1.89, P = 0.005),神经/神经障碍(AOR = 1.30, 95% CI: 1.05-1.60, P = 0.015),颞下颌关节卡压/卡压(AOR = 1.31, 95% CI: 1.08-1.60, P = 0.006),针头焦虑(AOR = 29.03, 95% CI: 23.80-35.52, P < 0.001),根管治疗史(AOR = 0.82, 95% CI: 0.68-0.99, P = 0.035)。结论:有临床相关比例的患者自我报告在牙科手术中难以麻醉。局部麻醉不足与女性性别、牙科恐惧、心理健康和神经系统疾病等变量之间的关系需要进一步调查。建议使用基于证据的局部麻醉方法和沟通实践,以尽量减少所经历的疼痛和随后的牙科护理恐惧。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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