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Emerg Med J doi:10.1136/emermed-2012-201980
  • Original article

Patient-controlled analgesia compared with interval analgesic dosing for reducing complications in blunt thoracic trauma: a retrospective cohort study

  1. Allan Kwok2,6
  1. 1Department of Emergency, St George Hospital, Sydney, New South Wales, Australia
  2. 2Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  3. 3Trauma Service, St George Hospital, Sydney, New South Wales, Australia
  4. 4Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
  5. 5The George Institute for Global Health, Sydney, New South Wales, Australia
  6. 6Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Stephen Edward Asha, Department of Emergency, St George Hospital, Gray St, Kogarah, NSW 2217, Australia; stephen.asha{at}sesiahs.health.nsw.gov.au
  • Received 16 September 2012
  • Revised 31 October 2012
  • Accepted 8 November 2012
  • Published Online First 6 December 2012

Abstract

Objectives To determine if complications from blunt thoracic trauma are reduced with patient-controlled analgesia (PCA) compared with interval analgesic dosing given as needed. Secondary aims were to investigate the influence of PCA on hospital length of stay (LOS) and cost.

Methods In this retrospective cohort study, patients were identified using the hospital trauma registry and clinical information department. Data on analgesic method, outcomes and confounders were obtained from the medical record. Costing data were obtained from the case-mix department. The analysis used logistic regression for the primary outcome and a generalised linear model for the secondary outcomes to adjust for potential confounders.

Results 227 patients were included. In the PCA group, 17/52 (33%) patients had a complication compared with 26/175 (15%) in the interval dosing group. The adjusted odds for a complication in patients receiving PCA was not significantly different from the adjusted odds in those receiving interval dosing (OR=1.2, 95% CI 0.3 to 4.6, p=0.83). The median LOS was 8.9 days in the PCA group and 4.6 days in the interval dosing group. The adjusted LOS for patients receiving PCA was 10% shorter than those receiving interval dosing (relative difference 0.9, 95% CI 0.6 to 1.3, p=0.52). The median hospital cost was $A11 107 in the PCA group (IQR $A7520–$A15 744) and $A4511 (IQR $A2687–$A8248) in the interval dosing group. The adjusted total hospital costs for patients receiving PCA was 10% higher than for those receiving interval dosing (relative difference 1.1, 95% CI 0.8 to 1.5, p=0.44).

Conclusions PCA did not reduce complications, hospital LOS or costs compared with interval analgesic dosing.