评估急诊科按年龄分列的抗牙痛药物处方模式。

Lisa Hsi, Shannon Ruiz
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引用次数: 0

摘要

背景:急性躁动经常发生在急诊科。适当的处理对所有相关人员的安全至关重要。苯二氮卓类药物和抗精神病药物是治疗躁动的常用药物,但这些药物对老年人的安全性存在担忧,即使是急性用药也是如此。本研究的目的是比较 18 至 64 岁的成年人和年龄≥ 65 岁的成年人抗激动药物的处方做法:本研究是对 2019 年 8 月 1 日至 2022 年 7 月 31 日期间在退伍军人事务南内华达医疗保健系统急诊科就诊并接受氟哌啶醇、屈哌利多、劳拉西泮、奥氮平或齐拉西酮治疗的患者进行的回顾性病历审查。如果退伍军人存在酒精中毒、酒精戒断、苯二氮卓类药物戒断或与躁动无关的用药情况,则排除在外。安全结果包括血氧饱和度<95%、补充氧气使用、插管、QTc延长以及用药后1小时内出现新的低血压:符合纳入标准的 232 名患者的基线特征差异显著。将年龄在 18 至 64 岁的患者与年龄≥ 65 岁的患者进行比较,年轻组群的药物使用障碍诊断率更高(55.3% vs 27.5%,P < .001),尿液药物筛查阳性率更高(69.7% vs 22.5%,P < .001)和 72 小时法定保留期(59.9% vs 32.5%,P < .001),而认知障碍或痴呆(0.7% vs 48.8%,P < .001)和精神状态改变相关诊断(2.0% vs 18.8%,P < .001)的比例较低。抗焦虑药物的选择因年龄而有明显差异(P = .02)。除了劳拉西泮(P = .007)外,其他药物的剂量没有明显差异。在安全性结果或额外抗凝药物剂量方面也未发现明显差异:结论:18 至 64 岁的成年人与年龄≥ 65 岁的成年人在抗焦虑处方方面可能存在差异。本研究结果还表明,最常见的激越病因可能因患者年龄而异。需要进行更多高质量的研究,以进一步探讨老年人的急性躁动问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of Anti-Agitation Medication Prescribing Patterns by Age in the Emergency Department.

Background: Acute agitation frequently occurs in the emergency department. Appropriate management is critical for the safety of all parties involved. Benzodiazepines and antipsychotics are commonly used for agitation, but safety concerns exist with these medications in older adults, even with acute use. The purpose of this study was to compare prescribing practices of anti-agitation medications between adults aged 18 to 64 years and those aged ≥ 65 years.

Methods: This study was a retrospective chart review of patients who presented to the Veteran Affairs Southern Nevada Healthcare System emergency department and received haloperidol, droperidol, lorazepam, olanzapine, or ziprasidone from August 1, 2019, to July 31, 2022. Veterans were excluded if they had alcohol intoxication, alcohol withdrawal, benzodiazepine withdrawal, or medication administration unrelated to agitation. Safety outcomes included oxygen saturation < 95%, supplemental oxygen use, intubation, QTc prolongation, and new hypotension within 1 hour of medication administration.

Results: For the 232 patients who met inclusion criteria, baseline characteristics differed significantly. When comparing patients aged 18 to 64 years and those aged ≥ 65 years, the younger cohort had higher rates of substance use disorder diagnosis (55.3% vs 27.5%, P < .001), positive urine drug screen (69.7% vs 22.5%, P < .001), and 72-hour legal hold (59.9% vs 32.5%, P < .001), and lower rates of cognitive impairment or dementia (0.7% vs 48.8%, P < .001), and altered mental status-related diagnosis (2.0% vs 18.8%, P < .001). Anti-agitation medication selection significantly differed based on age (P = .02). Other than lorazepam (P = .007), no significant differences were noted in the dose ordered. No significant differences were observed for safety outcomes or additional anti-agitation doses.

Conclusions: Anti-agitation prescribing practices may differ between adults aged 18 to 64 years and those aged ≥ 65 years. The findings of this study also suggest that the most common agitation etiologies may differ based on patient age. Additional higher-quality studies are needed to further explore acute agitation in older adults.

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