An Observational Study to Determine Whether Routinely Sending Patients Home With a 24-Hour Supply of Topical Tetracaine From the Emergency Department for Simple Corneal Abrasion Pain Is Potentially Safe - 17/05/18
, Ben Winrow, MBCHB a, Ian Densie, BSR b, Andrew Gray, BA, BCom c, Scott McMaster, DO a, George Giddings, MBCH a, John Meanley, MBCHB aAbstract |
Study objective |
To determine if the number of emergency department (ED) rechecks, persistent fluorescein uptake, ophthalmology referrals, or complications would be affected by the prescription of topical tetracaine for pain relief from simple corneal abrasions (SCAs).
Methods |
This retrospective cohort study was conducted in an ED where policy change allowed physicians to use topical tetracaine hydrochloride 1% eye drops for 24 hours for pain treatment for patients with corneal abrasions. Outcomes were compared between patients who did or did not received tetracaine (adjusting for the propensity for treatment).
Results |
Of 1,576 initial ED presentations, 532 were SCAs, with 1,044 deemed nonsimple corneal abrasions (NSCAs). Tetracaine was dispensed at the initial visit for 303 SCA presentations (57%) and inappropriately for 141 NSCA presentations (14%). There were no serious complications or uncommon adverse events attributed to tetracaine for all SCAs and NSCAs combined (0/459; upper 95% confidence interval [CI] 0.80%). The relative risks (RRs) of ED recheck and fluorescein staining were increased overall among patients who received tetracaine (RR 1.67, 95% CI 1.25 to 2.23; and RR 1.65, 95% CI 1.07 to 2.53 for recheck and staining, respectively). However, the relative risks for only SCAs receiving tetracaine was 1.16 (95% CI 0.69 to 1.93) and 0.77 (95% CI 0.37 to 1.62), respectively. Referrals to ophthalmology were significantly decreased for all patients (SCAs and NSCAs) dispensed tetracaine (relative risk 0.33; 95% CI 0.19 to 0.59). The number of complications was too small to permit modeling.
Conclusion |
There was no evidence that up to 24-hour topical tetracaine for the treatment of pain caused by SCA was unsafe; however, CIs were wide and some increased risks were observed for NSCAs.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 768 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Robert D. Welch, MD, MS |
|
| Author contributions: NW and ID conceived and designed the study, obtained ethical approval for the research, supervised the conduct of the study and data collection, and drafted the article. NW, BW, ID, SM, GG, and JM performed data collection. ID managed the data, including quality control. AG provided statistical advice on study design and analyzed the data in consultation with NW and ID. All authors contributed substantially to article revision. NW takes responsibility for the paper as a whole. |
|
| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. |
|
| Readers: click on the link to go directly to a survey in which you can provide YG2M39B to Annals on this particular article. |
|
| Continuing Medical Education exam for this article is available at ACEPeCME/. |
Vol 71 - N° 6
P. 767-778 - juin 2018 Retour au numéro
Article précédent
- How Older Adults Experience an Emergency Department Visit: Development and Validation of Measures
- Jane McCusker, Deniz Cetin-Sahin, Sylvie Cossette, Francine Ducharme, Alain Vadeboncoeur, T. T. Minh Vu, Nathalie Veillette, Antonio Ciampi, Eric Belzile, Simon Berthelot, Paul-André Lachance, Rick Mah
- Tetracaine Challenges Old Dogma for Emergency Department Management of Corneal Abrasion Pain and Beckons a Definitive Study
- Brennan M. Boyd, Robert Snyder
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?