A215 PATIENTS WITH INFLAMMATORY BOWEL DISEASE ARE FREQUENTLY PRESCRIBED OPIOID ANALGESICS WHEN DISCHARGED FROM THE EMERGENCY DEPARTMENT
Bibliographic record
Abstract
Abstract Background Patients with inflammatory bowel disease (IBD) suffer a substantial burden of morbidity related to chronic abdominal pain and are susceptible to opioid dependence and abuse that is associated with increased rates of depression, hospitalization, and mortality. While opioid prescription and renewal by a single provider minimizes the long-term risk of misuse, many patients with IBD will seek out care in the emergency department (ED) where short-term, ‘to-go’ use of narcotic analgesia is associated with potential treatment-related complications. Aims To assess rates of opioid prescription in IBD patients presenting to the ED and to assess factors associated with opioid use. Methods This is a retrospective analysis of cross-sectional data collected in the United States National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2006–2015. We compared a study population of adult IBD patients (International Classification of Diseases ICD-9 555.X, 556.X) ≥18 years discharged from the ED to a control group of patients presenting with non-specific abdominal pain (ICD-9 789.0, 564.1, 536.8). The proportion of patients given opioids in ED and at ED discharge were calculated with relative standard error (RSE), and national level estimates were produced using survey weights. Univariable and multivariable logistic regression was used to evaluate predictors of opioid prescription at discharge, expressed as odds ratios (OR) with 95% confidence intervals (CI). Results A total of 767,577 IBD patients were compared to 71,359,257 patients with non-specific abdominal pain. A total of 37.3% (RSE 4.7%) of IBD patients compared to 24.7% (RSE 0.8%) of controls (p<0.01) received an opioid prescription on ED discharge. 49.1% (RSE 5.6%) of IBD patients compared to 37.2% (RSE 0.8%) of patients with non-specific abdominal pain (p=0.02) received an opioid while in ED. Significant predictors of narcotic prescription at discharge in multivariable analysis included: age <50 (OR 6.83 [95% CI: 1.21, 38.48], p=0.03), non-white race (OR 4.73 [95% CI: 1.46, 15.39], p=0.01), and narcotic use in the ED (OR 5.27 [95% CI: 1.96, 14.21], p<0.01). Conclusions Nearly 40% of IBD patients were prescribed an opioid at discharge from the ED. This rate is significantly higher than for patients who present with non-specific abdominal pain and younger, non-white IBD patients were disproportionately more likely to receive an opioid prescription. Given the risks associated with on-demand narcotic use in IBD patients, our data highlight a potential gap in care for accessing comprehensive pain management solutions. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".