The display effects of patients’ self-assessment on traumatic acute pain on the proportion and timing of analgesics administration in the emergency department

Abstract

BackgroundAcute pain assessment in the emergency department (ED) is important in particular during the triage process. Early pain assessment and management improve outcome. The objective of this study was to determine the effects of documentation and display of patient's self-assessment of pain using numerical rating scale (NRS) on analgesic use among adult trauma patients in ED.MethodsA randomized control trial was conducted recruiting 216 trauma patients who presented to ED of two tertiary centers. Pain score was done using NRS for all patients. They were randomized into pain score display group or not displayed in the control. The outcome measured were proportion of patients receiving analgesics and timing from triage to analgesic administration.ResultsThe proportion of patients who received analgesics when pain score was displayed was 6.5% more than when pain score was not displayed. This difference was however not statistically significant. However, stratified categorical analysis using chi-square showed that the displayed severe pain group was 1.3 times more likely to receive analgesics compared to the non-displayed group. The mean timing to analgesic administration for the displayed and non-displayed groups were 81.3 ± 41.2 (95% C.I 65.9, 96.7) and 88.7 ± 45.4 (95% C.I 69.0, 108.3), respectively (p > 0.05).ConclusionsThe proportion of patients who received analgesics increased when NRS was displayed. However, the pain display has no significant effect on the timing of analgesics.

Acute pain management in the trauma patient population: are we doing enough? A prospective observational study

“…Using the researcher-collected data, the preanalgesia pain score for severe pain was close to 60% and 80% with the SPS and FAS scoring systems, respectively. This correlates well with other studies [27,28]. Every patient was provided with analgesia, with a mean door-to-needle time of 55 minutes.…”

Increased analgesia administration in emergency medicine after implementation of revised guidelines

“…An explanation for the missing NRS in this subgroup could be that their injuries/diseases were of such urgency that they had to be transferred to the operation room or intensive care unit immediately. If we had been able to measure the NRS in this high urgency (with expected high NRS scores) category, one could expect the effect of our intervention to be the same or even larger, because analgesic administration is significantly associated with increasing severity of pain [ 19 , 20 ].…”

“…The smaller effect in our study might be explained by the differences in baseline NRS scores. Though the median NRS was comparable, there were less patients in the post-group with higher NRS scores, possibly leading to less analgesics administration [ 20 ].…”

Pain Prevalence and Pain Management in a Chinese Hospital

“…Indeed, as early as 2002 the International Association Study for the Pain (IASP) advocated recognizing pain intensity as the fifth vital sign, in addition to the traditional 4 vital signs of body temperature, blood pressure, pulse, and breathing [ 2 ]. During recent decades, important progress has been made in the study and treatment of several painful conditions, but pain is still underestimated and under-treated in medical practices [ 3 – 7 ], especially in developing countries [ 8 ]. As a result, the presence of pain among hospitalized patients is extensive, and significantly more would be expected.…”