title: Analgesic practice for acute orthopedic trauma pain in Costa Rican emergency departments.
abstract: OBJECTIVE
  Studies in US emergency departments have demonstrated that pain is undertreated in adults and children. Previous studies have also demonstrated cultural differences in the expression and perception of pain. The objective of this investigation was to describe the analgesic practices and patient pain responses in two Costa Rican EDs in light of possible differences due to cultural variation.
  
  
  METHODS
  We carried out a prospective, noninterventional observational assessment protocol of a convenience sample of patients being treated for orthopedic trauma in two university-affiliated urban teaching hospital EDs. Children between the ages of 5 and 12 years and all adults, ages 16 to 63, who presented with painful orthopedic trauma were included. Patients quantified their pain on arriving at and before leaving the ED. Children used a Face Interval Scale ranging from 1 (no pain) to 9 (maximum pain), and adults used a numeric rating scale ranging from 0 to 10.
  
  
  RESULTS
  One fourth of pediatric and more than half of all adult patients had no reduction in their pain scores on leaving the ED. Eleven percent of adults and fewer than 4% of children received pain treatment while in the ED. Fewer than half of all patients were sent home with analgesics. We observed no use of opioids in the ED for analgesia.
  
  
  CONCLUSIONS
  Our data illustrate that both adults and children with severe pain resulting from orthopedic injury in the Costa Rican EDs we studied often receive inadequate or no analgesic treatment. This finding suggests that the phenomenon of oligoanalgesia is more widespread and resistant to cultural differences. We also noted a reluctance to use opioids in this setting.
authors: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors: T J
authors: TJ
authors: Jantos
authors: P M
authors: PM
authors: Paris
authors: J J
authors: JJ
authors: Menegazzi
authors: D M
authors: DM
authors: Yealy
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000698:Analgesia / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003364:Costa Rica; D003466:Cultural Characteristics; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000706:statistics & numerical data; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement / Q000706:statistics & numerical data; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*