Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults

Abstract

Objective The objective of this study was to determine predictive factors for pain-related emergency department returns in middle-aged and older adults. Design, Setting, and Subjects. This was a subanalysis of patients > 55 years of age enrolled in a prospective observational study of adult patients presenting within 30 days of an index visit to a large, urban, academic center. Methods Demographic and clinical data were collected and compared to determine significant differences between patients who returned for pain and those who did not. Multiple logistic regressions were used to determine significant predictive variables for return visits. Results The majority of the 130 enrolled patients > 55 years of age returned for pain (57%), were African American (78%), were younger (55–64 years old, 67%), had a high emergency department acuity level (level 1 or 2) at their index visit (56%), had low health literacy (Rapid Estimate of Adult Literacy in Medicine [REALM] score, 62%), lived in an area of extreme deprivation (69%), and were admitted (61%) during their index visit. Age (odds ratio [OR] = 0.9, 95% CI = 0.8–0.9, P = 0.047), health literacy (REALM scores; OR = 3.1, 95% CI = 1.3–7.5, P = 0.011), and index visit pain scores (OR = 1.1, 95% CI = 1.0–1.2, P = 0.004) were predictive of emergency department returns for pain in middle-aged and older adults. Conclusions The likelihood of emergency department return visits for pain in middle-aged and older adults decreased with older age, increased with higher health literacy (REALM scores), and increased with increase in pain scores.

Development and Validation of a Nomogram for Predicting Risk of Emergency Department Revisits in Chinese Older Patients

“…Although previous evidence reached consensus that older adults encountered more ED returns when compared with younger adults, the increasing age, within the spectrum of the older population, has yet demonstrated contradictory results. Some studies coincided with our finding that the oldest old were less prone to re-visit, [33][34][35] whereas others concluded that the likelihood of returning to EDs increased concurrently with advancing age. 5,11,13,28 Such inconsistencies in the age effect highlight the importance of considering factors that can more accurately reflect biological or functional age (eg, frailty) rather than simply chronological age in the geriatric population evaluation.…”

Association between Migraine and Quality of Life, Mental Health, Sleeping Disorders, and Health Care Utilization Among Older African American Adults

“…To review the scope of the challenges that vulnerable populations are facing, Charleston and colleagues in 2018 argued that underrepresented minority patients encounter numerous healthcare barriers, including lack of access, insurance coverage of treatment, transportation to and from appointments, and prohibitive costs [ 18 ]. A recent study conducted by Sheikh and colleagues in 2020 examining predictive factors for pain-related ED returns in middle-aged and older adults, revealed that African Americans who return to the ED for pain have low health literacy [ 50 ].…”

Comparing Pain Intensity Using the Numeric Rating Scale and Defense and Veterans Pain Rating Scale in Patients Revisiting the Emergency Department

“…The NRS predicting ED administration of opioid medications in our patient sample demonstrates the power of pain scales to influence pain management, specifically opioid administration, in acute care settings like the ED. Others have also reported associations between unidimensional pain scales and increased analgesia administration and opioid adverse events [ 14 , 15 ]. Our results of increasing NRS pain category severity predicting ED opioid administration and DVPRS differentiating between moderate and high levels of pain coupled together suggest that patients may receive fewer opioid medications in the ED if the DVPRS (and not NRS) is used to measure pain intensity.…”

“…This study was a secondary analysis of data collected from the University of Florida Institutional Review Board-approved prospective observational study of 389 patients ≥18 years of age returning to the ED within 30 days of an initial (index) visit (Figure 1 ). Full study details have been published previously [ 15 , 16 ]. Briefly, all community-dwelling adult patients reporting to our ED and able to provide consent were eligible for inclusion.…”