Analgesia delivery in the ED

Grant, Paul

doi:10.1016/j.ajem.2006.05.004

Cited by 73 publications

(58 citation statements)

References 11 publications

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“…However, ED staff have identified a lack of confidence and familiarity with pain assessment in people with cognitive impairment, especially in those with dementia 6. Available guidelines indicate that timely analgesia is important, recognised as a human right and should be provided for those in severe pain within 20 min7 or within a maximum of 60 min2 from time of arrival in ED.…”

Section: Objectivementioning

confidence: 99%

Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

2017

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Objective The primary objective of the study was to measure the impact of an observational pain assessment dementia tool on time from ED arrival to first dose of analgesic medicine. Methods A multisite cluster randomised controlled trial was conducted to test the Pain Assessment in Advanced Dementia (PAINAD) tool. Patients aged 65 years or older suspected of a long bone fracture were screened for cognitive impairment using the Six-Item Screening (SIS) tool. Patients scoring 4 or less on SIS (intervention sites) were assessed for pain using PAINAD. Control sites, assessed pain using standard methods. The primary outcome was time to first dose of analgesia and was analysed on an intention-to-treat basis with a sensitivity analysis. results We enrolled 602 patients, of which 323 (54%) were at intervention sites (n=4). The median time to analgesia was 82 min (IQR 45-151 min). There was no statistically significant difference in median time to analgesia for intervention 83 (IQR 48-158 min) and nonintervention 82 min (IQR 41-147 min) sites (p=0.414). After adjusting for age, fracture type, arrival mode and triage category, there remained no significant difference in time to analgesia (HR 0.97, 95% CI 0.80 to 1.17, p=0.74). Of the 602 patients enrolled, 273 actually had cognitive impairment. A sensitivity analysis demonstrated patients at intervention sites received analgesia 13 min sooner (90 vs 103 min, p=0.91). conclusion Use of the PAINAD was not associated with a shorter time to analgesia, although there was a clinically important but non-significant improvement in the cognitively impaired patient group. Further research is needed to address this clinically important and complex issue.

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Section: Objectivementioning

confidence: 99%

Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

2017

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“…[1][2][3] Optimal pain management is lacking in most EDs, as many patients do not receive analgesia [3][4][5][6][7][8][9][10][11][12] and time to analgesic administration is often too long. 3,[5][6][7][8][10][11][12][13][14][15][16][17][18][19] Most health care professionals underestimate pain intensity. 20,21 In the absence of tachycardia or hypertension, we observed that ED staff tend to discredit self-assessments of severe pain when patients do not appear to be suffering.…”

Section: Introductionmentioning

confidence: 99%

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Daoust

Paquet

Bailey

et al. 2015

CJEM

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Objectives: This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain. Methods: We performed a retrospective analysis of real-time, archived data from an electronic medical record system at an urban teaching hospital and regional community hospital. We included consecutive ED patients ≥16 years old who had a self-reported pain intensity ≥1 as measured during triage, from March 2005 to December 2012. The primary outcome was vital signs for self-reported pain intensity levels (mild, moderate, severe) on an 11-point verbal numerical scale. Changes in pain intensity levels were also compared to variations in vital signs. Both analyses were repeated on a subgroup of patients with diagnosed conditions recognized to produce significant pain: fracture, dislocation, or renal colic. Results: We included 153,567 patients (mean age of 48.4 ± 19.3 years; 55.5% women) triaged with pain (median intensity of 7/10 ± 3). Of these, 8.9% of patients had diagnosed conditions recognized to produce significant pain. From the total sample, the difference between mild and severe pain categories was 2.7 beats/minutes (95% CI: 2.4 − 3.0) for heart rate and 0.13 mm Hg (95% CI: -0.26 − 0.52) for systolic blood pressure. These differences generated small effect sizes and were not clinically significant. Results were similar for patients who experienced changes in pain categories and for those conditions recognized to produce significant pain. Conclusion: Health care professionals cannot use vital signs to estimate or substantiate self-reported pain intensity levels or changes over time. RÉSUMÉObjectif: L'étude visait à confirmer l'existence d'une association entre l'intensité de la douleur autodéclarée et les signes vitaux enregistrés chez des patients au service des urgences (SU) ainsi que dans un sous-groupe de malades souffrant d'affections connues pour causer de fortes douleurs. Méthode: Les auteurs ont procédé à une analyse rétro-spective de données enregistrées en temps réel et archivées dans un système de dossiers médicaux électroniques, dans un centre hospitalier universitaire urbain et dans un hôpital communautaire régional. Ont participé à l'étude des patients consécutifs, âgés de ≥16 ans, qui ont fait état, au SU, de douleurs d'une intensité ≥1, mesurée durant le triage, de mars 2005 à décembre 2012. Le principal critère d'évaluation était les signes vitaux associés à différents degrés d'intensité (légère, modérée, forte) de la douleur autodéclarée sur une échelle numérique, verbale, de 11 points. Les variations de l'intensité de la douleur ont également été comparées aux variations des signes vitaux. Les deux analyses ont été reprises dans un sous-groupe de patients souffrant d'affections connues pour causer de fortes douleurs: fracture, luxation ou colique néphrétique. Résultats: Ont participé à l'étude 153 567 patients (âge moyen: 48,4 ± 19,3 ans; femm...

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“…Wallace et al point out that physicians' inadequate knowledge remains a significant barrier to pain management, as clinicians do not seem to notice the gaps in their knowledge or the need to fill them [8,26]. A frequent reason for inadequate pain management in emergency departments is the conviction that analgesia conceals clinical symptoms, which may lead to worse treatment outcomes [20,27]. Over three quarters of physicians postpone the administration of opioid analgesia to patients until a surgical consultation is carried out [20].…”

Section: Physician-related Barriersmentioning

confidence: 99%

Problems and Barriers in Ensuring Effective Acute and Postoperative Pain Management - an International Perspective

Mędrzycka‐Dąbrowska

Dąbrowski²,

Basiński

2015

Adv Clin Exp Med

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Pain management originated at the turn of the 1960s and 70s in the United States, and spread to Western Europe almost a decade later. It is estimated today that a lack of adequate pain management affects 80% of the global population, and is a serious problem in over 150 countries. At the national level, the greatest burden of inadequate pain management is borne by the elderly, pregnant and breastfeeding women, children, people coping with addictions to harmful substances, and the mentally ill. In spite of enormous progress, there are still significant barriers to comprehensive pain management. Pain management should be considered a priority. It is an interdisciplinary task requiring the cooperation of the whole medical staff. The current review of literature revealed a number of factors limiting the possibility of achieving effective pain management, related to healthcare systems, medical staff and patients (Adv Clin Exp Med 2015, 24, 5, 905-910).

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Analgesia delivery in the ED

Cited by 73 publications

References 11 publications

Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Problems and Barriers in Ensuring Effective Acute and Postoperative Pain Management - an International Perspective

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