在急诊科检查肌注与静脉注射甲氧氯普胺治疗急性头痛的效果以加快吞吐量。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-06-01 DOI:10.1016/j.jemermed.2025.01.007

Andrew R. Barbera MD , Lauren A. Gould DO, MS , Walter B. Wills MS , Eden Crowsey MS , Kenneth Rosever II MA, MBA , Brandon Montes BS , Kellcee Johnson MS , Fred Blind MD , James Melton MD

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引用次数: 0

摘要

背景：许多治疗方法存在于偏头痛症状的预防性和流产性治疗中。尽管许多这些治疗方法对偏头痛没有特异性，但它们显示出足够的证据，并获得了重要的医学专业共识，可用于治疗急性偏头痛。甲氧氯普胺是一种已知对停止偏头痛症状特别有效的止吐药。目的：本研究的目的是检查肌肉注射（i.m.）和静脉注射（i.v）甲氧氯普胺在急诊科（ED）住院时间（LOS）和缓解偏头痛患者疼痛方面的差异。作为次要结果，我们还评估了这些组之间治疗主观疼痛的疗效。方法：这是一项单中心回顾性研究，纳入了2020年1月至2022年9月期间主要诊断为急性偏头痛或非特异性头痛并在就诊期间静脉注射甲氧氯普胺的成年ED患者。倾向匹配用于平衡注射组和静脉注射组之间的协变量，并调整混杂因素，包括辅助治疗。结果：在倾向匹配之前和之后，与静脉注射甲氧氯普胺相比，静脉注射甲氧氯普胺降低了LOS。在倾向评分匹配之前，静脉注射甲氧氯普胺患者的中位LOS为67 min（四分位数间距[IQR] 42.50, 99.50），静脉注射患者的中位LOS为168 min (IQR = 137, 234)（中位差异= 102,95%可信区间[CI] 93-112， r = 0.44, p < 0.001）。倾向匹配后，静脉给药的中位LOS为73 min (IQR 47, 103)，静脉给药的中位LOS为166 min (IQR 129, 259)（中位差异= 97,95% CI 81-144, r = 0.68, p < 0.001）。所有结果的CI均为95%。两组患者在减轻疼痛方面无显著差异。结论：肌内注射甲氧氯普胺治疗急症急性头痛与静脉注射相比，中位LOS降低，临床疗效相似。

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Examining the Effect of Intramuscular versus Intravenous Metoclopramide for Treatment of Acute Headaches to Expedite Throughput in the Emergency Department

Background

Numerous therapies exist for both prophylactic and abortive treatments of migraine headache symptoms. Although many of these treatments are nonspecific to migraine headache, they show sufficient evidence and have garnered significant medical professional consensus for off-label use to treat acute migraine headache. One antiemetic known to be particularly effective in ceasing migraine headache symptoms is metoclopramide.

Objective

The purpose of this study is to examine the difference between intramuscular (i.m.) vs. intravenous (i.v.) metoclopramide on emergency department (ED) length of stay (LOS) and pain relief in patients presenting with presumed migraine headache. As a secondary outcome, we also assess the efficacy in treating subjective pain between these groups.

Methods

This was a single-center, retrospective study of adult ED patients presenting between January 2020 and September 2022 with a principal diagnosis of acute migraine or nonspecific headache and receiving i.m. or i.v. metoclopramide during their visit. Propensity matching was utilized to balance covariates between the i.m. and i.v. groups and adjust for confounding factors, including adjuvant therapies.

Results

LOS was decreased when i.m. metoclopramide was utilized as opposed to i.v. metoclopramide, both prior to and after propensity matching. Prior to propensity score matching, patients who received i.m. metoclopramide had a median LOS of 67 min (interquartile range [IQR] 42.50, 99.50), and patients with i.v. administration had a median LOS of 168 min (IQR 137, 234) (median difference = 102, 95% confidence interval [CI] 93–112, r = 0.44, p < 0.001). After propensity matching, median LOS for i.m. administration was 73 min (IQR 47, 103) and i.v. administration was 166 min (IQR 129, 259) (median difference = 97, 95% CI 81–144, r = 0.68, p < 0.001). A 95% CI was utilized for all outcomes. There was no significant difference in pain reduction between the two groups.

Conclusion

Intramuscular administration of metoclopramide for the treatment of acute headache in the ED is associated with a decreased median LOS compared with i.v. administration with similar clinical efficacy.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine