PCA vs Interval Analgesic Dosing for Blunt Thoracic Trauma
PCA vs Interval Analgesic Dosing for Blunt Thoracic Trauma
Of the 227 patients who satisfied the inclusion and exclusion criteria, 52 (23%) received PCA and 175 (77%) received interval analgesic dosing. Patients in the PCA group received PCA treatment for a median of 2.6 days (IQR 1.3–4.4). The minimum time on PCA was 0.5 days and the maximum was 9.0 days. Expressed as a proportion of total hospital stay, the median proportion of time patients in the PCA group received PCA was 38% (IQR 19–57%), with a minimum of 4% and a maximum of 95%. Patient who received PCA tended to be younger, have more severe injuries (higher ISS) and have higher-energy injury mechanisms than those receiving interval dosing analgesia. These baseline characteristics are presented in Table 1 and Table 2, which outline the univariate associations between potential confounding variables and each of the primary and secondary outcome variables. Smoking status was not evaluated owing to a large proportion of missing values.
Seventeen patients (33%, 95% CI 20% to 47%) in the PCA group had a complication, compared with 26 (15%, 95% CI 10% to 21%) in the interval dosing group. After adjusting for confounding variables, the odds of a complication occurring in patients receiving PCA was 1.2 (95% CI 0.3 to 4.6, p=0.83) times higher than the odds of a complication occurring among those receiving interval dosing. The median hospital LOS was 8.9 days (IQR 5.4–11.7) in the PCA group and 4.6 days (IQR 2.0–8.0) for the interval dosing group. After adjusting for the effects of confounding variables, the hospital LOS for patients receiving PCA was 10% shorter than the LOS of patients receiving interval dosing (relative difference 0.9, 95% CI 0.6 to 1.3, p=0.52). The median cost of the hospital stay was $A11 107 in the PCA group (IQR $A7520–$A15 744) and $A4511 (IQR $A2687–$A8248) in the interval dosing group. After adjusting for the effects of confounding variables, the total hospital costs for patients receiving PCA was 10% higher than those for patients receiving interval dosing (relative difference 1.1, 95% CI 0.8 to 1.5, p=0.44).
Given the null result we undertook a further exploratory analysis of the primary outcome, examining the influence of PCA in a more severely injured patient population defined by more than two rib fractures. One hundred and eight patients had more than two rib fractures—39 (36%, 95% CI 27% to 46%) received a PCA and 69 (64%, 95% CI 54% to 73%) received interval analgesic dosing. In this more severely injured subgroup, after adjusting for confounding variables, the odds of a complication occurring in patients receiving PCA was 1.6 (95% CI 0.5 to 5.8, p=0.46) times higher than the odds of a complication occurring among those receiving interval dosing.
Results
Of the 227 patients who satisfied the inclusion and exclusion criteria, 52 (23%) received PCA and 175 (77%) received interval analgesic dosing. Patients in the PCA group received PCA treatment for a median of 2.6 days (IQR 1.3–4.4). The minimum time on PCA was 0.5 days and the maximum was 9.0 days. Expressed as a proportion of total hospital stay, the median proportion of time patients in the PCA group received PCA was 38% (IQR 19–57%), with a minimum of 4% and a maximum of 95%. Patient who received PCA tended to be younger, have more severe injuries (higher ISS) and have higher-energy injury mechanisms than those receiving interval dosing analgesia. These baseline characteristics are presented in Table 1 and Table 2, which outline the univariate associations between potential confounding variables and each of the primary and secondary outcome variables. Smoking status was not evaluated owing to a large proportion of missing values.
Seventeen patients (33%, 95% CI 20% to 47%) in the PCA group had a complication, compared with 26 (15%, 95% CI 10% to 21%) in the interval dosing group. After adjusting for confounding variables, the odds of a complication occurring in patients receiving PCA was 1.2 (95% CI 0.3 to 4.6, p=0.83) times higher than the odds of a complication occurring among those receiving interval dosing. The median hospital LOS was 8.9 days (IQR 5.4–11.7) in the PCA group and 4.6 days (IQR 2.0–8.0) for the interval dosing group. After adjusting for the effects of confounding variables, the hospital LOS for patients receiving PCA was 10% shorter than the LOS of patients receiving interval dosing (relative difference 0.9, 95% CI 0.6 to 1.3, p=0.52). The median cost of the hospital stay was $A11 107 in the PCA group (IQR $A7520–$A15 744) and $A4511 (IQR $A2687–$A8248) in the interval dosing group. After adjusting for the effects of confounding variables, the total hospital costs for patients receiving PCA was 10% higher than those for patients receiving interval dosing (relative difference 1.1, 95% CI 0.8 to 1.5, p=0.44).
Given the null result we undertook a further exploratory analysis of the primary outcome, examining the influence of PCA in a more severely injured patient population defined by more than two rib fractures. One hundred and eight patients had more than two rib fractures—39 (36%, 95% CI 27% to 46%) received a PCA and 69 (64%, 95% CI 54% to 73%) received interval analgesic dosing. In this more severely injured subgroup, after adjusting for confounding variables, the odds of a complication occurring in patients receiving PCA was 1.6 (95% CI 0.5 to 5.8, p=0.46) times higher than the odds of a complication occurring among those receiving interval dosing.
