The objective of this cohort study was to determine the association between the use of tramadol in emergency departments and the later consumption of opioids at the outpatient level in a group of patients from Colombia. Based on a medication dispensation database, patients over 18 years of age treated in different clinics in Colombia who for the first time received tramadol, dipyrone, or a nonsteroidal anti-inflammatory drug (NSAID) in the emergency room between January and December 2018 were identified. Three mutually exclusive cohorts were created, and each patient was followed up for 12 months after the administration of the analgesic to identify new formulations of any opioid. A Cox proportional-hazards regression model was constructed to identify variables associated with receiving a new opioid. A total of 12,783 patients were identified: 6020 treated with dipyrone, 5309 treated with NSAIDs, and 1454 treated with tramadol. The mean age was 47.1 ± 20.4 years, and 61.6% were women. A total of 17.3% (n = 2207) of all patients received an opioid during follow-up. Those treated with tramadol received a new opioid with a higher frequency (n = 346, 23.8%) than the other cohorts (14.7% NSAIDs and 17.9% dipyrone, both ). In the tramadol group, using more than 10 mg of morphine equivalents was associated with a greater use of new opioids (HR:1.47, 95%CI:1.12–1.93). Patients treated with tramadol in emergency departments have a higher risk of opioid use at the one-year follow-up than those treated with NSAIDs or dipyrone.

中文翻译：

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在急诊科治疗的患者中使用曲马多或其他镇痛药是使用阿片类药物的危险因素

这项队列研究的目的是确定在哥伦比亚急诊科中使用曲马多与门诊病人后来服用阿片类药物之间的相关性。根据药物分配数据库，确定了2018年1月至2018年12月间在急诊室首次接受曲马多，双嘧啶或非甾体抗炎药（NSAID）的哥伦比亚不同诊所治疗的18岁以上患者。 。创建了三个互斥的队列，并且在给予镇痛药后对每个患者进行了12个月的随访，以发现任何阿片类药物的新配方。构建了Cox比例风险回归模型，以识别与接受新阿片类药物相关的变量。总共确定了12,783例患者：用双嘧啶处理6020，用非甾体抗炎药处理的5309和曲马多处理的1454。平均年龄为47.1±20.4岁，女性为61.6％。总计17.3％（n  = 2207）在随访期间接受了阿片类药物治疗。接受曲马多治疗的患者接受新阿片类药物的频率更高（n  = 346，23.8％），高于其他人群（分别为14.7％的NSAID和17.9％的双嘧啶））。在曲马多组中，使用10毫克以上的吗啡当量与更多使用新的阿片类药物有关（HR：1.47，95％CI：1.12-1.93）。在急诊科接受曲马多治疗的患者在一年的随访中比使用非甾体抗炎药或双嘧啶治疗的患者具有更高的阿片类药物使用风险。