title: Pain in an emergency department: an audit.
abstract: OBJECTIVE
  To evaluate the quality of care in patients with pain who visit the emergency department of a university hospital and the evolution of their pain during their emergency department stay.
  
  
  METHODS
  A cross-sectional survey was performed using two valid scales (a numerical descriptor scale or a verbal pain intensity scale), and a structured questionnaire to patients and use of patient charts to collect information on pain intensity on arrival and before discharge, characteristics of pain and of its management.
  
  
  RESULTS
  In the 726 participating patients, median age was 37 years (range: 18-97), and 54% of the patients were men. Upon arrival, 563 patients presented with pain (78%), rated > or =7 in 35% of the 390 patients evaluated using numerical descriptor scale. Forty-four percent had taken analgesics before arrival. Their median waiting time before initial medical examination was 30 min. Pain was identified by triage nurses (70%) or by physicians (77%) and was rated by nurses (23%) and physicians (11%). Forty-seven percent also experienced pain during care and 27% received analgesics during their stay. Pain intensity remained unchanged in 70% of patients, increased in 7% and decreased in 23%. Of the 480 patients with pain on arrival evaluated before discharge, 395 (82%) patients were unrelieved before going home, rated > or =7 in 32% of the 390 patients evaluated using numerical descriptor scale. Analgesics were ordered before leaving the emergency department in 81%.
  
  
  CONCLUSIONS
  Even if pain has been identified, its assessment and management remains inadequate. The quality of care may be improved by educating the personnel in developing protocols and in evaluating pain management.
authors.affiliation: AP-HP, Emergency Department, Cochin - Saint Vincent de Paul - La Roche Guyon Hospital, 27, Street Faubourg Saint Jacques, 75014, Paris, France. fabienne.karwowski-soulie@wanadoo.fr
authors.forename: Fabienne
authors.initials: F
authors.lastname: Karwowski-Soulié
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Lessenot-Tcherny
authors.forename: Agathe
authors.initials: A
authors.lastname: Lamarche-Vadel
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bineau
authors.forename: Christine
authors.initials: C
authors.lastname: Ginsburg
authors.forename: Olivier
authors.initials: O
authors.lastname: Meyniard
authors.forename: Brigitte
authors.initials: B
authors.lastname: Mendoza
authors.forename: Pascale
authors.initials: P
authors.lastname: Fodella
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Vidal-Trecan
authors.forename: Fabrice
authors.initials: F
authors.lastname: Brunet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D010147:Pain Measurement; D010297:Paris; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014218:Triage
chemical_list: D000700:Analgesics