Quality of pain management in the emergency department: results of a multicentre prospective study

Guéant, S.; Taleb, Ariski; Borel-Kühner, Jocelyne; Cauterman, M.; Raphaël, Maurice; Nathan, Guillaume; Ricard-Hibon, A.

doi:10.1097/eja.0b013e3283418fb0

Cited by 94 publications

(84 citation statements)

References 31 publications

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“…En cuanto a los fármacos administrados, como sucede en los países de nuestro entorno, los AINE y paracetamol son los más utilizados, con bajo uso de opioides mayores, aunque superan a los reflejados en otros estudios (9). Actitudes como esperar a tener un diagnóstico y la opiofobia parecen seguir estando presentes.…”

Section: Discussionunclassified

“…En cualquier caso, la presión asistencial se ha considerado que es un factor que puede influir negativamente en el adecuado control del dolor (9,12).…”

Section: Discussionunclassified

“…Estudios realizados en hospitales norteamericanos identifican la oligoanalgesia como una constante instalada desde hace varias décadas en los emergency departments, donde el porcentaje de pacientes que experimenta dolor de intensidad grave puede ser tan alto como del 78 % y los tratamientos analgésicos utilizados son escasamente efectivos (1)(2)(3)(4)(5)(6)(7). Igualmente, estudios recientes han venido a demostrar cómo Europa no es ajena a una realidad en la que el dolor no se evalúa lo suficiente, los analgésicos potentes son infrautilizados y el retardo en el tratamiento es común en estos servicios (8)(9)(10)(11). Aunque el conocimiento y el análisis de este problema ha servido como punto de partida para la implementación de medidas útiles para la mejora en el manejo del dolor en esta particular área (12)(13)(14)(15)(16), al igual que ha ocurrido con el dolor agudo postoperatorio (17), estas medidas no se han generalizado ni han resuelto el problema.…”

Section: Introductionunclassified

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Encuesta nacional sobre dolor en las urgencias hospitalarias

Barrientos

Alcalá

Pérez³

et al. 2014

Rev. Soc. Esp. Dolor

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C. Encuesta nacional sobre dolor en las urgencias hospitalarias. Rev Soc Esp Dolor 2014; 21(1): 3-15. ABSTRACTObjective: To determine the epidemiology and management of acute pain in the emergency services (ES) of Spanish hospitals.Method: Survey "on line" to doctors responsible for the ES from a sample of different types of hospital across the country. Aspects of pain epidemiology, assessment, institutional resources, types of treatments and specific training aspects in pain practitioners in the field of ES are investigated.Results: With a response rate of 37 % is estimated that 42.8 % of patients come to the ES with pain as the main reason. Musculoskeletal pain is the most represented and more intense. Is usually assessed by scales in 58.3 % of hospitals, although only 23.9 % have specific documentation to do so. Major opioids are used in 16.9 % of patients with pain, weak opioids in 25.4 % and acetaminofen/NSAID 72.3 %. Possess analgesic protocols refer 46.3 %, and acute pain services or institutional pain programs (APS-IPP) 13.4 %. Only 20.9 % of the hospitals have specific training activity in this area. With few differences between them, hospitals with APS-IPP tend to evaluate and document the pain, using more opioids and protocols, while providing more training.Conclusion: Pain is still present and is underevaluated in the ES. At the institutional and individual level there is ample room for improvement in this field must consider new strategies, attitudes and organizational solutions. RESUMENObjetivo: Conocer aspectos epidemiológicos y del manejo del dolor agudo en los servicios de urgencia (SU) de los hospitales españoles.Método: Encuesta on line a los responsables médicos de los SU de una muestra de diferentes tipos de hospitales de todo el territorio nacional. Se investigan aspectos relativos a la epidemiología del dolor, evaluación, recursos institucionales, tipos de tratamientos y aspectos formativos específicos en dolor de los profesionales en el ámbito de los SU.Resultados: Con una tasa de respuesta del 37 % se estima que el 42,8 % de los pacientes acuden a los SU con dolor como principal motivo. El dolor músculo-esquelético es el más representado y de mayor intensidad. Se evalúa habitualmente mediante escalas en el 58,3 % de los hospitales, aunque sólo el 23,9 % tienen documentación específica para hacerlo. Opioides mayores se utilizan en el 16,9 % de los pacientes con dolor, opioides débiles en el 25,4 % y paracetamol/AINE en el 72,3 %.Refieren poseer protocolos analgésicos el 46,3 % y unidades de dolor agudo o programas institucionales de dolor (UDA-PID) el 13,4 %. Sólo el 20,9 % de los hospitales realiza actividad formativa específica en este ámbito. Con escasas diferencias entre centros, los hospitales con UDA-PID tienden a evaluar y documentar más el dolor, utilizan más los opioides mayores, los protocolos y facilitan más la formación.Conclusión: El dolor sigue estando presente y es infravalorado en los SU. A nivel institucional e individual existe un amplio margen de mejora en este campo q...

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Section: Discussionunclassified

“…En cualquier caso, la presión asistencial se ha considerado que es un factor que puede influir negativamente en el adecuado control del dolor (9,12).…”

Section: Discussionunclassified

Section: Introductionunclassified

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Encuesta nacional sobre dolor en las urgencias hospitalarias

Barrientos

Alcalá

Pérez³

et al. 2014

Rev. Soc. Esp. Dolor

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“…3,6,7 However, two large multicenter studies have showed that pain scores are usually obtained only once in emergency department (ED) patients. 2,4 This suggests a lack of reassessment after initial treatment, which would presumably preclude implementation of analgesic titration. Such practice seems entirely plausible, given the difficulty of reassessment of patients' pain in an overcrowded ED.…”

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confidence: 99%

“…There is evidence that doses of analgesics given in practice are not large enough to achieve satisfactory analgesia for many patients. [1][2][3][4][5] Titration of analgesia appears to constitute the ideal strategy for management of acute pain. 3,6,7 However, two large multicenter studies have showed that pain scores are usually obtained only once in emergency department (ED) patients.…”

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confidence: 99%

Randomized Clinical Trial of Efficacy and Safety of a Single 2‐mg Intravenous Dose of Hydromorphone Versus Usual Care in the Management of Acute Pain

Chang

Bijur

Lupow

et al. 2013

Academic Emergency Medicine

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Objectives: The objective was to test the efficacy and safety of 2 mg of intravenous (IV) hydromorphone (Dilaudid) against "usual care" in emergency department (ED) patients with acute severe pain.Methods: This was a randomized clinical trial. Patients allocated to 2 mg of IV hydromorphone received their medication in a single dose. Those randomized to usual care received any IV opioid, with type, dose, and frequency chosen by the ED attending. All patients received 2 L/min. nasal cannula oxygen. The primary outcome was the difference in the proportion of patients who achieved clinically satisfactory analgesia by 30 minutes. This was defined as the patient declining additional analgesia when asked the question, "Do you want more pain medicine?" A 10% absolute difference was chosen a priori as the minimum difference considered clinically significant.Results: Of 175 subjects randomized to each group, 164 in the 2 mg hydromorphone group and 161 in the usual care group had sufficient data for analysis. Additional pain medication was declined by 77.4% of patients in the 2 mg hydromorphone group at 30 minutes, compared to 65.8% in the usual care group. This difference of 11.6% was statistically and clinically significant (95% confidence interval [CI] = 1.8% to 21.1%). Safety profiles were similar and no patient required naloxone. There was more pruritus in the hydromorphone group (18.3% vs. 8.7%; difference = 9.6%, 95% CI = 2.6% to 16.6%).Conclusions: Using a simple dichotomous patient-centered endpoint in which a difference of 10% in proportion obtaining adequate analgesia was considered clinically significant, 2 mg of hydromorphone in a single IV dose is clinically and statistically more efficacious when compared to usual care for acute pain management in the ED.ACADEMIC EMERGENCY MEDICINE 2013; 20:185-192

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Comparison between pupillometry and numeric pain rating scale for pain assessments in communicating adult patients in the emergency department

Gregoire,

Charier,

de Bergeyck

et al. 2023

European Journal of Pain

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ObjectiveThe adequate assessment of pain in the emergency department (ED) can be challenging. Two dynamic pupillary measures used in conscious subjects after a surgical procedure were previously shown to correlate to the magnitude of ongoing pain. The objective of this study was to test the ability of dynamic measures derived from pupillometry to evaluate pain intensity in conscious adult patients admitted to the ED.MethodsThis prospective, interventional, single‐centre study was performed between August 2021 and January 2022 (NCT05019898). An assessment of self‐reported pain intensity was performed on ED admission by the triage nurse using a numeric rating scale (NRS). This was followed by two dynamic measures derived from pupillometry that were previously correlated with pain perception: the pupillary unrest under ambient light (PUAL) and the pupillary light reflex (PLR).ResultsAmong the 313 analysed patients, the median age was 41 years, and 52% were women. No correlation was found between self‐reported pain ratings and PUAL (r = 0.007) or PLR (baseline diameter r = −0.048; decrease r = 0.024; latency r = 0.019; slope = −0.051). Similarly, the pupillometry measures could not discriminate patients with moderate to severe pain (defined as NRS ≥4).ConclusionsPupillometry does not appear to be an effective tool to evaluate pain in the ED environment. Indeed, too many factors influencing the sympathetic system—and thus the dynamic pupillary measures—are not controllable in the ED.SignificancePupillometry does not appear to be an effective tool to evaluate pain in the ED environment.There are several possible explanations for these negative results. The factors influencing the sympathetic system—and thus the PD fluctuations—are controllable in the postoperative period but not in the ED (e.g. full bladder, hypothermia). In addition, numerous psychological phenomena can impact pupillometry measurements such as emotional reactions or cognitive tasks. These phenomena are particularly difficult to control in the ED environment.

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Quality of pain management in the emergency department: results of a multicentre prospective study

Cited by 94 publications

References 31 publications

Encuesta nacional sobre dolor en las urgencias hospitalarias

Encuesta nacional sobre dolor en las urgencias hospitalarias

Randomized Clinical Trial of Efficacy and Safety of a Single 2‐mg Intravenous Dose of Hydromorphone Versus Usual Care in the Management of Acute Pain

Comparison between pupillometry and numeric pain rating scale for pain assessments in communicating adult patients in the emergency department

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