Table 3.
Multivariable regression results. Adjusted odds of (1) receiving an opioid analgesic during the ED visit or (2) being discharged from the ED with a prescription opioid analgesic in a population of 2,352 adult ED patients with suspected urolithiasis.
| Predictor variables | (1) Opioid analgesic during visit ORa (95% CI) |
(2) Opioid analgesic at ED discharge ORa (95% CI) |
|---|---|---|
| Likelihood of urolithiasis diagnosis >50% | 1.70 (1.40–2.07) | –b |
| Urolithiasis diagnosis | –b | 4.24 (3.48–5.18) |
| Pain severity at arrival to ED (0–10) | ||
| Low (0–3) | 1.00 (ref) | 1.00 (ref) |
| Medium (4–8) | 4.19 (2.81–6.26) | 1.87 (1.36–2.56) |
| High (9 or 10) | 9.06 (6.23–13.18) | 2.55 (1.94–3.36) |
| >24 hours in pain before arrival | 0.82 (0.67–1.01) | 0.74 (0.59–0.92) |
| Has health care insurance | 1.23 (0.99–1.53) | 1.27 (1.02–1.60) |
| Race/ethnicity | ||
| Non-Hispanic white | 1.00 (ref) | 1.00 (ref) |
| Non-Hispanic Black or African American | 0.80 (0.58–1.10) | 0.82 (0.60–1.13) |
| Hispanic | 0.72 (0.55–0.94) | 0.96 (0.73–1.25) |
| Mixed or other race | 0.88 (0.63–1.24) | 1.07 (0.83–1.37) |
| More than high school education | 0.99 (0.84–1.16) | 1.29 (1.05–1.59) |
| Self-rated health | ||
| Excellent, very good, good | 1.00 (ref) | 1.00 (ref) |
| Fair or poor | 1.43 (1.11–1.85) | 0.94 (0.76–1.16) |
| Male gender | 0.88 (0.74–1.04) | 0.95 (0.76–1.19) |
| Age (continuous, years) | 1.00 (1.00–1.01) | 1.01 (1.00–1.02) |
| Months since August 2011 | 0.98 (0.96–1.01) | 0.96 (0.94–0.99) |
| Online access to state PDMP | 1.29 (0.82–2.02) | 1.64 (1.06–2.53) |
Odds ratios estimated by a multivariable model with GEE estimation, a logit link, and robust standard errors clustered within each of 15 hospitals in the study sample of 2,352 adults with suspected urolithiasis with non-missing data for outcomes and variables in model (final sample from Table 1).
Variable not included in model. Diagnosis was recorded at the end of the visit, temporally after the first outcome, so the physician’s initial assessment of the likelihood of having urolithiasis was used instead to predict opioid analgesic administration during the visit.
Abbreviations: ED, emergency department; OR, odds ratio; CI, confidence interval; PDMP, prescription drug monitoring program; GEE, generalized estimating equation.