Does Early Opioid Use for Relief of Acute Abdominal Pain Increase Use of Abdominal CT or Prolong Emergency Department Length of Stay?

Introduction Opioid use is common for emergency department (ED) patients presenting with undifferentiated abdominal pain (AbdPain). Whether the potential analgesic benefits of opioids are offset by prolonged ED length of stay (LOS)—possibly due to extended evaluations or increased diagnostic testing—remains unclear. The primary objective was to determine whether administration of an opioid, compared to a nonopioid drug, as initial analgesia in AbdPain patients is associated with longer ED LOS after adjusting for demographics and pain severity. Secondary objectives evaluated whether initial opioid use was associated with higher adjusted likelihood of ordering abdominal CT (CTabd) or white blood cell count (WBC) testing. Methods This retrospective observational study analyzed 4 months of electronic health record data from a single UK health system, including consecutive adult ED patients presenting with AbdPain who received analgesia and had a documented pain score. Variables included demographic factors, initial pain level, and analgesic administered. ED workup variables included diagnostic testing (CTabd, WBC), LOS, and disposition. Categorical data were summarized as proportions with binomial exact 95% confidence intervals (CIs); continuous data were summarized with medians and interquartile ranges (IQRs). Univariable analyses used Wilcoxon rank‐sum or Pearson’s χ 2 tests. Multivariable analyses employed quantile median regression for LOS and logistic regression for secondary outcomes. Results During the study period, there were 884 patients meeting eligibility criteria. The median ED LOS was 7.7 h (IQR 5.0 to 11.9). CTabd and WBC were ordered in 362 (41.0%) and 797 (90.2%) of cases. Univariable analysis showed no association between initial opioid use and ED LOS ( p = 0.255), CTabd ordering ( p = 0.404), or WBC testing ( p = 0.820). Multivariable modeling adjusting for operational factors, demographics, and pain score confirmed no significant association between initial opioid use and ED LOS (coefficient 0.18, 95% CI: −0.71–1.08, p = 0.684), CTabd (OR 1.12, 95% CI: 0.84–1.50, p = 0.430), or WBC testing (OR 0.91, 95% CI: 0.58–1.43, p = 0.698). Conclusions Among ED patients with abdominal pain, initial opioid administration was not associated with longer LOS or increased use of diagnostic testing.