Longitudinal Trends in the Treatment of Abdominal Pain in an Academic Emergency Department

Çınar, Orhan; Jay, Loni; Fosnocht, David E.; Carey, Jessica; Rogers, LeGrand; Carey, Adrienne; Horne, Benjamin D.; Madsen, Troy

doi:10.1016/j.jemermed.2013.01.020

Cited by 11 publications

(13 citation statements)

References 20 publications

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“…Several studies reported follow-up at less than 1 month postintervention, when the ‘honeymoon’ effect would likely still be strong. Outcomes from studies with significantly longer follow-up risk contamination due to secular trends 61. The time periods used to assess preintervention and postintervention outcomes were often not comparable in terms of length of time and seasonality, despite ED attendances being highly seasonal59 and correlation between quality indicators and ‘busyness’ of a department 62.…”

Section: Resultsmentioning

confidence: 99%

Interventions to improve the management of pain in emergency departments: systematic review and narrative synthesis

2014

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Section: Resultsmentioning

confidence: 99%

Interventions to improve the management of pain in emergency departments: systematic review and narrative synthesis

2014

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“…Only 60% of patients with AAP in a Slovenian hospital were satisfied with their pain management upon discharge . In comparison, in a US hospital, episodes of analgesic administration for patients with AAP generally increased from 39.9% in 2000 to 65.5% in 2010. Nevertheless, many patients still reported moderate to severe pain at discharge .…”

Section: Introductionmentioning

confidence: 93%

Clinical protocols for adults with acute abdominal pain in Australian emergency departments

Chong

Schultz

Donnelly

2019

Evaluation Clinical Practice

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Rationale, Aims and Objectives: Patients with acute abdominal pain are a common presentation in hospital emergency departments; however, international studies have demonstrated that hospitals often lack clinical protocols to guide care. This study aimed to investigate whether Australian hospital emergency departments have acute abdominal pain clinical protocols, identify hospital-level predictors of the presence of these clinical protocols, and assess the quality of protocols. Methods: A survey was sent to all Australian hospitals with emergency departments, collecting data on hospital characteristics and the presence of acute abdominal pain clinical protocols. Participating hospitals (n = 73, 26% response rate) were also asked to provide a copy of these protocols. The quality of these protocols was assessed using Appraisal of Guidelines for REsearch & Evaluation (AGREE) II.Results: Slightly more than half (n = 40) of the hospitals surveyed had acute abdominal pain clinical protocols, while 16 had a general pain protocol. In binomial logistic regression, two independent variables were related to the presence of a protocol, geographic region (P = 0.008) and advanced practice nurses/nurse practitioners' presence on staff (P = 0.024). The mean score for the overall quality assessment of these protocols was 4.2 on a seven-point Likert scale; in terms of the six domains of quality, "Clarity of presentation" and "Scope and purpose" were highest. The overall quality of clinical protocols increased with remoteness, χ 2 (3) = 8.341, P = 0.039, and was lower in hospitals with medical staff on site (U = 2.5, P = 0.007).Conclusion: There is a documented standard for pain management of acute abdominal pain in about three quarters of participating Australian emergency departments. The use and quality of clinical protocols is influenced by the physical location of hospitals and staff and skill mix of clinicians.

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“…Although it is widely recognized that severe pain is very common in EDs, studies have shown that up to 70% of patients do not receive analgesics during their stay in the ED . Moreover, it has been indicated that pain treatment is often delayed in the ED; in general, it is started after clinical examination or at the end of the diagnostic investigation . The average waiting time is estimated to range from 70 to 90 minutes before the first administration of analgesia, with a dose often insufficient to relieve patients’ discomfort .…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Moreover, it has been indicated that pain treatment is often delayed in the ED; in general, it is started after clinical examination or at the end of the diagnostic investigation. [4][5][6][7] The average waiting time is estimated to range from 70 to 90 minutes before the first administration of analgesia, with a dose often insufficient to relieve patients' discomfort. 4,7,8 For all these reasons, patients presenting in EDs remain largely dissatisfied.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7] The average waiting time is estimated to range from 70 to 90 minutes before the first administration of analgesia, with a dose often insufficient to relieve patients' discomfort. 4,7,8 For all these reasons, patients presenting in EDs remain largely dissatisfied. [9][10][11] Over the past 2 decades, medical societies have sought to initiate recommendations to improve the treatment of pain, which is now regarded as the fifth vital sign.…”

Section: Introductionmentioning

confidence: 99%

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Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain

et al. 2019

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Objectives To evaluate the effect on opioid requirement of pain treatment starting at triage, and to evaluate satisfaction in emergency department (ED) patients with acute pain. Methods This is a single‐blind, randomized, prospective study conducted in the ED. The included patients were randomly assigned to single oral doses of placebo, acetaminophen, or a tramadol/acetaminophen combination. Protocol treatment was given at triage. The primary outcome was the need for rescue morphine during ED stay. The secondary outcome included patient satisfaction, ED length of stay, and percentage of patients discharged from the ED with a VAS score of <30. Results We included 1,485 patients: 496 patients in the placebo group, 497 in the acetaminophen group, and 492 in the tramadol/acetaminophen combination group. The groups were similar regarding demographic and clinical characteristics and baseline VAS pain scores. Rescue morphine was significantly decreased in the tramadol/acetaminophen combination group compared to that in the placebo and acetaminophen groups (11.5%, 23.2%, and 18.9%, respectively; P = 0.03). Patient satisfaction was higher in the tramadol/acetaminophen combination group (77% vs. 69% in the acetaminophen group and 68% in the placebo group). A VAS score of <30 was observed in 84% of patients in the placebo group, 83% in the acetaminophen group, and 87% in the tramadol/acetaminophen combination group (P = 0.01 between the acetaminophen group and tramadol/acetaminophen combination group). The ED length of stay was 60 minutes for the acetaminophen group and tramadol/acetaminophen combination group and 71 minutes for the placebo group (P = 0.04). Conclusion Oral tramadol/acetaminophen combination administered early in triage was associated with a decrease in intravenous morphine requirement and increase in satisfaction among ED patients with acute pain when compared with patients taking acetaminophen. No significant increase in side effects was found. This intervention may be considered in EDs with an aim of similar benefits.

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Longitudinal Trends in the Treatment of Abdominal Pain in an Academic Emergency Department

Cited by 11 publications

References 20 publications

Interventions to improve the management of pain in emergency departments: systematic review and narrative synthesis

Interventions to improve the management of pain in emergency departments: systematic review and narrative synthesis

Clinical protocols for adults with acute abdominal pain in Australian emergency departments

Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain

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