BACKGROUND Pain gained recognition as a vital sign in the early 2000s, underscoring the importance of accurate documentation, characterization, and treatment of pain. No prior studies have demonstrated the utility of the 0-10 pain scale with respect to discharge opioid prescriptions, nor characterized the most influential factors in discharge prescriptions. METHODS Inpatient and emergency department(ED) encounters from July 1, 2012 to April 1, 2018 resulting in a discharge prescription for tablet opioid medications were identified. The primary outcome was to determine if pain levels in 24 h prior to discharge correlated with opioids (in milligrams of morphine equivalents (MME)) prescribed. Secondary outcomes included the impact of patient and prescriber demographics, demographics. A generalized linear model was created to investigate factors affecting the quantity of prescribed opioids. RESULTS n = 78,691 patient encounters. Overall mean adjusted MME for non-ED visits was 378 versus 197 for ED visits. Whites received the highest quantities; those identifying as non-white and non-black received the lowest. Women received significantly fewer discharge MMEs in both the ED and inpatient cohorts. Provider prescribing patterns exhibited the most profound effect on discharge MMEs. The most prolific (≥300 prescriptions over the study period) writing the largest amount. In the ED, there was a significant negative correlation between documented pain levels and discharge MMEs(ρ = 0.074,p < 0.001). CONCLUSIONS Pain scale was significantly negatively correlated with discharge MMEs in the ED and positively correlated in the inpatient population. Individual prescriber characteristics were the more influential variable, with prolific high prescribers writing for the largest MME amounts. The inverse association of pain and MMEs at discharge in the ED, and the large effect pre-existing prescriber patterns exhibited, both improved methodology for assessing and appropriately treating pain, and effective prescriber-targeted interventions, must be a priority.

中文翻译：

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错误的生命体征：当疼痛程度不能预测出阿片类药物处方时。

背景技术在2000年代初期，疼痛得到了认可，这是一个重要的信号，强调了准确记录，表征和治疗疼痛的重要性。既往研究尚未证明0-10疼痛量表对出院阿片类药物处方的效用，也没有表征出出院阿片类药物中影响最大的因素。方法确定2012年7月1日至2018年4月1日住院和急诊科（ED）的遭遇，确定了阿片类药物的出院处方。主要结果是确定出院前24小时的疼痛程度是否与处方的阿片类药物（以吗啡当量（MME）毫克计）相关。次要结果包括患者和处方药人口统计学，人口统计学的影响。建立了广义线性模型以研究影响处方阿片类药物数量的因素。结果n = 78,691患者遭遇。非急诊就诊的平均调整后MME为378，急诊就诊为197。白人的数量最多。那些被识别为非白人和非黑人的人得到的最低。在急诊室和住院患者中，妇女接受出院的MME明显减少。提供者的处方模式对放电MME表现出最深远的影响。最多产的（在研究期间≥300张处方）最多。在急诊室，所记录的疼痛水平与出院MME之间存在显着的负相关性（ρ= 0.074，p <0.001）。结论疼痛量表在急诊室与出院MMEs显着负相关，在住院人群中正相关。个体处方者特征是更具影响力的变量，多产的高处方者写出最大的MME量。急诊室出院时疼痛与MME的逆相关性，以及先前存在的处方者模式表现出的巨大影响，评估和适当治疗疼痛的改良方法以及针对处方者的有效干预措施都必须成为首要任务。