The effects of acute pain on cognitive skills in emergency department patients.

INTRODUCTION: Effective pain management results in improved patient satisfaction, reduced anxiety, and improved comfort. However, concern exists regarding the effects of pain medications on cognition and patient ability to consent for procedures, hospital admission, or to refuse recommended medical interventions. METHODS: This prospective, case-control study was conducted at a Level 1 Trauma Center. Eligible subjects included ED patients ages 18 and older with a triage pain score of 1 or higher, who received non-narcotic analgesic agents. Cognition was measured before and after non-narcotic pain medication using the Digit Symbol Substitution Test (DSST). A control group consisted of 35 healthy volunteers who completed the DSST at baseline and one hour. RESULTS: Among 46 subjects, the mean age was 33. The mean triage pain score was 7. Before medication, the average DSST score was 39.5. After medication, the average DSST score was 42.9. There was a significant within-subject average change in DSST score (pre-post) of 3.4 (95% confidence interval: 1.6, 5.2), p < 0.001. Among the control group, the mean baseline DSST score was 64.2 (SD 10.7). One hour later the mean DSST score had increased to 71.1 (SD 10.4). Overall, the mean within-subject change over time in DSST was 6.9 (SD 8.0) with 95% CI 4.2 to 9.7. There was not enough evidence to detect relationships between change in DSST scores and age, triage pain, triage HR, triage RR, change in pain scores, gender, ethnicity, mode of arrival nor insurance (all with p > 0.05). CONCLUSIONS: We found significant variation in DSST scores among ED patients with pain. Treatment of pain with nonsedating analgesic agents was not associated with improved scores on the Digit Symbol Substitution Test among ED patients with acute painful conditions, compared to control subjects.

Penetrating trauma: Relationships to recreational drug and alcohol use.

INTRODUCTION: The incidence of alcohol and recreational drug use is increasing. The impact on penetrating trauma is unknown. This study was undertaken to identify the incidence of alcohol and recreational drug use prior to penetrating trauma, and to identify ISS and outcomes among patients with penetrating trauma. METHODS: In this retrospective study, eligible subjects included trauma patients age 18 and older, with major trauma (admitted or evaluated by the Trauma Team) from 2017 to 2021. A chart review was conducted to identify data including mechanism of injury, ISS, alcohol level, toxicologic testing, length of stay, and final disposition. RESULTS: Among 1270 adult subjects with penetrating trauma during 2017 through 2020, the majority were male (N = 1071; 84%), and African American (N = 679; 54.3%) or White (N = 537; 42.9%). Mechanisms of injury included gunshot wound (GSW) (N = 973; 76.6%) or stab wound (N = 297; 23.4%). Injury severity score (ISS) ranged from 1 to 75. Among 426 subjects (33.5%) tested for recreational drugs, 395 (93%) were positive for at least one substance. The most common recreational drugs identified included marijuana (N = 280; 65.7%), benzodiazepine ((N = 131;30.8%), alcohol ((N = 248; 25.3%), opiate ((N = 116; 27.2%), cocaine (N = 87; 20.4%), and amphetamine ((N = 84; 19.7%). Subjects with an ISS of 9 to 15 had higher odds of testing positive for opiates compared to subjects with an ISS of 1 to 3 (OR 2.3). Most patients were ultimately discharged home ((N = 912;71.8%) and a minority expired (N = 142; 11.2%). CONCLUSIONS: Positive screens for alcohol and recreational drugs were common among penetrating trauma patients in this setting. The most common identified recreational drugs included marijuana, benzodiazepine, opiates, alcohol, cocaine, and amphetamine.