European journal of emergency medicine : official journal of the European Society for Emergency Medicine · 2025
Patient gender and opioid administration in the emergency department for acute low back pain: a retrospective study in 17 French emergency departments.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Bannelier Héloïse, Teissandier Dorian, Joubert Fanny, Jiang Cheng, Freund Yonathan, Vromant Amélie
Аннотация
BACKGROUND AND IMPORTANCE: Low back pain (LBP) is a common reason for emergency department (ED) visits, but its management remains variable across sites and providers. Opioid use for acute LBP is controversial, and possible gender-related disparities in prescribing practices have been reported in other clinical settings. Understanding whether such disparities exist in ED care is important for ensuring equitable treatment.
OBJECTIVE: We aimed to determine whether patient gender influences the likelihood of opioid administration in the ED for acute LBP.
DESIGN: Multicenter retrospective observational cohort study.
SETTINGS AND PARTICIPANTS: Seventeen French EDs participated. Adults aged 20-55 years presenting between 1 January and 1 July 2024, with acute mechanical LBP of less than 6 weeks' duration and without clinical red flags were included.
EXPOSURE: The exposure of interest was patient gender. Pain severity was assessed at triage using the Numeric Rating Scale (NRS).
OUTCOME MEASURES AND ANALYSIS: The primary outcome was opioid administration in the ED. Opioid use was first compared between men and women across pain severity categories (mild: NRS 1-3, moderate: 4-6, severe: 7-10). Multivariable logistic regression adjusted for initial NRS was then performed, and sensitivity analyses using multiple imputation addressed missing NRS values.
MAIN RESULTS: A total of 558 patients were included, of whom 236 (42.3%) were women. The median initial NRS was 5.0 [interquartile range (IQR): 3-7]; 61 patients (10.9%) had missing NRS values. Overall, opioids were administered in 43.9% of visits (codeine 12.7%, tramadol 14.9%, and morphine 19.4%). No significant gender differences were observed across pain categories: mild [20.6 vs. 17.9%; odds ratio (OR): 1.19, 95% confidence interval (CI): 0.40-3.39], moderate (50.7 vs. 42.0%; OR: 1.42, 95% CI: 0.78-2.58), and severe (73.3 vs. 72.3%; OR: 1.05, 95% CI: 0.52-2.10). In multivariable analysis, gender was not associated with either opioid use (OR: 1.16, 95% CI: 0.77-1.75) or morphine use (OR: 1.14, 95% CI: 0.69-1.89). Sensitivity analyses yielded similar findings.
CONCLUSION: In this multicenter retrospective study, gender did not significantly influence opioid or morphine administration in patients presenting with acute low back pain in the ED.
OBJECTIVE: We aimed to determine whether patient gender influences the likelihood of opioid administration in the ED for acute LBP.
DESIGN: Multicenter retrospective observational cohort study.
SETTINGS AND PARTICIPANTS: Seventeen French EDs participated. Adults aged 20-55 years presenting between 1 January and 1 July 2024, with acute mechanical LBP of less than 6 weeks' duration and without clinical red flags were included.
EXPOSURE: The exposure of interest was patient gender. Pain severity was assessed at triage using the Numeric Rating Scale (NRS).
OUTCOME MEASURES AND ANALYSIS: The primary outcome was opioid administration in the ED. Opioid use was first compared between men and women across pain severity categories (mild: NRS 1-3, moderate: 4-6, severe: 7-10). Multivariable logistic regression adjusted for initial NRS was then performed, and sensitivity analyses using multiple imputation addressed missing NRS values.
MAIN RESULTS: A total of 558 patients were included, of whom 236 (42.3%) were women. The median initial NRS was 5.0 [interquartile range (IQR): 3-7]; 61 patients (10.9%) had missing NRS values. Overall, opioids were administered in 43.9% of visits (codeine 12.7%, tramadol 14.9%, and morphine 19.4%). No significant gender differences were observed across pain categories: mild [20.6 vs. 17.9%; odds ratio (OR): 1.19, 95% confidence interval (CI): 0.40-3.39], moderate (50.7 vs. 42.0%; OR: 1.42, 95% CI: 0.78-2.58), and severe (73.3 vs. 72.3%; OR: 1.05, 95% CI: 0.52-2.10). In multivariable analysis, gender was not associated with either opioid use (OR: 1.16, 95% CI: 0.77-1.75) or morphine use (OR: 1.14, 95% CI: 0.69-1.89). Sensitivity analyses yielded similar findings.
CONCLUSION: In this multicenter retrospective study, gender did not significantly influence opioid or morphine administration in patients presenting with acute low back pain in the ED.