Pain scores improve analgesic administration patterns for trauma patients in the emergency department.
OBJECTIVE
To determine the efficacy of pain scores in improving pain management practices for trauma patients in the emergency department (ED).


METHODS
A prospective, observational study of analgesic administration to trauma patients was conducted over a nine-week period following educational intervention and introduction of verbal pain scores (VPSs). All ED nursing and physician staff in an urban Level I trauma center were trained to use the 0-10 VPS. Patients younger than 12 years old, having a Glasgow Coma Scale score (GCS) <8, or requiring intubation were excluded from analysis. Demographics, mechanism of injury, vital signs, pain scores, and analgesic data were extracted from a computerized ED database and patients' records. The staff was blinded to the ongoing study.


RESULTS
There were 150 patients studied (183 consecutive trauma patients seen; 33 patients excluded per criteria). Pain scores were documented for 73% of the patients. Overall, 53% (95% confidence interval [CI] = 45% to 61%) of the patients received analgesics in the ED. Of the patients who had pain scores documented, 60% (95% CI = 51% to 69%) received analgesics, whereas 33% (95% CI = 18% to 47%) of the patients without pain scores received analgesics. No patient with a VPS < 4 received analgesics, whereas 72% of patients with a VPS > 4 and 82% with a VPS > 7 received analgesics. Mean time to analgesic administration was 68 minutes (95% CI = 49 to 87).


CONCLUSIONS
Pain assessment using VPS increased the likelihood of analgesic administration to trauma patients with higher pain scores in the ED.
Burns and Allen Research Institute, Ruth and Harry Roman Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. paul.silka@cshs.org
Paul A
PA
Silka
Mendel M
MM
Roth
Greg
G
Moreno
Lindsay
L
Merrill
Joel M
JM
Geiderman
D000328:Adult; D017677:Age Distribution; D000700:Analgesics / Q000008:administration & dosage*; D002140:California; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D012044:Regression Analysis; D017678:Sex Distribution; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*
D000700:Analgesics