老年创伤患者的阿片类药物中毒和阿片类药物使用障碍。
Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients.
机构信息
Centre d'Étude en Médecine d'Urgence, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada.
Département Médecine Familiale et Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada.
出版信息
Clin Interv Aging. 2020 May 27;15:763-770. doi: 10.2147/CIA.S252849. eCollection 2020.
BACKGROUND
Patients hospitalized following a traumatic injury will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (<3 months) opioid use after discharge and the risk of opioid poisoning or use disorder in older trauma patients.
METHODS
In a retrospective multicenter cohort study conducted on registry data, we included all patients ≥65 years admitted (hospital stay >2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for opioid poisoning and opioid use disorder from ICD-9 to ICD-10 code diagnosis after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not, using Cox proportional hazards regressions.
RESULTS
A total of 70,314 admissions were retained for analysis; median age was 82 years (IQR: 75-87), 68% were women, and 34% of the patients filled an opioid prescription within 3 months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1-5), 192 participants (0.27%; 95% CI: 0.23%-0.31%) were hospitalized for opioid poisoning and 73 (0.10%; 95% CI: 0.08%-0.13%) were diagnosed with opioid use disorder. Having filled an opioid prescription within 3 months of injury was associated with an increased hazard ratio of opioid poisoning (2.8; 95% CI: 2.1-3.8) and opioid use disorder (4.2; 95% CI: 2.4-7.4) after the injury. However, history of opioid poisoning (2.6; 95% CI: 1.1-5.8), of substance use disorder (4.3; 95% CI: 2.4-7.7), or of the opioid prescription filled (2.8; 95% CI: 2.2-3.6) before the trauma, was also related to opioid poisoning or opioid use disorder after the injury.
CONCLUSION
Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with a history of substance use disorder, opioid poisoning or opioid use.
背景
创伤后住院的患者在住院期间和出院后经常会使用阿片类药物。我们研究了出院后急性期（<3 个月）使用阿片类药物与老年创伤患者阿片类药物中毒或使用障碍风险之间的关系。
方法
在一项回顾性多中心队列研究中，我们纳入了 2004 年至 2014 年期间在魁北克省 57 家创伤中心住院（住院时间>2 天）的所有年龄≥65 岁的患者。我们根据 ICD-9 至 ICD-10 代码诊断，在初次受伤后搜索阿片类药物中毒和阿片类药物使用障碍。将在创伤后 3 个月内开具阿片类药物处方的患者与未开具处方的患者进行比较，使用 Cox 比例风险回归。
结果
共纳入 70314 例住院患者进行分析；中位年龄为 82 岁（IQR：75-87），68%为女性，34%的患者在初次创伤后 3 个月内开具了阿片类药物处方。在中位随访 2.6 年（IQR：1-5）期间，192 名患者（0.27%；95%CI：0.23%-0.31%）因阿片类药物中毒住院，73 名患者（0.10%；95%CI：0.08%-0.13%）被诊断为阿片类药物使用障碍。在创伤后 3 个月内开具阿片类药物处方与创伤后阿片类药物中毒（2.8；95%CI：2.1-3.8）和阿片类药物使用障碍（4.2；95%CI：2.4-7.4）的风险比增加相关。然而，阿片类药物中毒史（2.6；95%CI：1.1-5.8）、物质使用障碍史（4.3；95%CI：2.4-7.7）或创伤前开具的阿片类药物处方（2.8；95%CI：2.2-3.6）也与创伤后阿片类药物中毒或阿片类药物使用障碍有关。
结论
老年创伤患者住院后阿片类药物中毒和阿片类药物使用障碍是罕见事件。然而，对于有物质使用障碍、阿片类药物中毒或阿片类药物使用障碍史的患者，应谨慎使用阿片类药物。
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