{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T20:58:44Z","timestamp":1793480324723,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,11,20]],"date-time":"2018-11-20T00:00:00Z","timestamp":1542672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K23 AG033100\u201001A7"],"award-info":[{"award-number":["K23 AG033100\u201001A7"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Older adults are at risk for undertreatment of pain. We examined intravenous (<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>) acetaminophen as an analgesic adjunct to <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> opioids in the care of older emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) patients with acute severe pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a randomized clinical trial conducted in two <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s in the Bronx, New York. Eligible adults aged 65 years and older with acute severe pain were randomized to 0.5 mg of <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> hydromorphone and 1 g of <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> acetaminophen or 0.5 mg of <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> hydromorphone and 100 <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content> of normal saline placebo. The primary outcome was the between group difference in improvement of numerical rating scale (<jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content>) pain scores at 60 minutes. Secondary outcomes were the between\u2010group differences in the proportion of patients who chose to forgo additional pain medications at 60 minutes; the proportion who developed side effects; the proportion who required rescue analgesia; and between\u2010group differences in <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content> pain scores at 5, 15, 30, and 45 minutes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty\u2010one patients were allocated to each arm. Eighty patients in the <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> acetaminophen arm and 79 patients in the placebo arm had sufficient data for analysis. At 60 minutes, patients in the hydromorphone + <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> acetaminophen group improved by 5.7 <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content> units while those in the hydromorphone + placebo group improved by 5.2 <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content> units, for a difference of 0.6 <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content> units (95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] = \u20130.4 to 1.5). A total of 28.7% of patients in the hydromorphone + <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> acetaminophen group wanted more analgesia at 60 minutes versus 29.1% in the hydromorphone + placebo group, for a difference of \u20130.4% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = \u201314.3% to 13.5%). These differences were neither clinically nor statistically significant. Safety profiles were similar in both groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this randomized clinical trial, the addition of <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> acetaminophen to <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> hydromorphone as an adjunctive analgesic for acute, severe, pain in older adults provided neither clinically nor statistically superior pain relief when compared to hydromorphone alone within the first hour of treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13556","type":"journal-article","created":{"date-parts":[[2018,8,17]],"date-time":"2018-08-17T20:11:19Z","timestamp":1534536679000},"page":"402-409","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Randomized Clinical Trial of Intravenous Acetaminophen as an Analgesic Adjunct for Older Adults With Acute Severe Pain"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8123-4006","authenticated-orcid":false,"given":"Andrew K.","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Albany Medical College Albany NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polly E.","family":"Bijur","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashar","family":"Ata","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albany Medical College Albany NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caron","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Pearlman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"White","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Chertoff","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Restivo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Bronx NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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