title: Analgesic efficacy of orodispersible paracetamol in patients admitted to the emergency department with an osteoarticular injury.
abstract: BACKGROUND
  Acute pain still persists in patients under treatment after admission to emergency departments (ED). The objective of this study was to determine the efficacy of 1 g of paracetamol in patients presenting an osteoarticular injury.
  
  
  METHODS
  This prospective study included all patients admitted to the ED with an osteoarticular injury and a pain score above 30 on the visual analogue scale (VAS). Patients were selected on admission by the reception nurse and given paracetamol within 5 min of admission. VAS scores were recorded 30 and 60 min after admission. On discharge from the ED, the patients underwent a further VAS assessment and were asked a question about pain relief (yes/no answer). The primary endpoint was the VAS score at 60 min. The secondary endpoint was the pain relief expressed by the patient on discharge from the ED.
  
  
  RESULTS
  Five hundred and seventy-one patients were included. The median stay in the ED was 90 min (75-120 min). The diagnoses at discharge were sprain or dislocation (ankle, knee, and wrist) for 287 patients, fracture for 102 patients, and other injury for 182 patients. In 69% of the patients, the injured limb was immobilized. The median VAS score on admission was 57. A significant difference was seen between the median VAS on admission and at 1 h after admission (57+/-18 vs. 30+/-18; P<0.0001), and between the median VAS score at admission and the score at discharge from the ED (57+/-18 vs. 26+/-18, P<0.0001). Finally, 81% of the patients expressed pain relief. On discharge from the ED, a gain of 20 mm on the VAS had a positive predictive value of 93% [area under curve (AUC): 89; CI: 86-92; P=0.001], for the endpoint 'patients stating pain relief'.
  
  
  CONCLUSIONS
  A simple and easily applicable protocol of pain management permits the achievement of satisfactory analgesia during a patient's stay in the ED.
authors.affiliation: Emergency and Intensive Care Units, Bellevue Hospital, Saint-Etienne, France. alain.viallon@univ-st-etienne.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Viallon
authors.forename: Olivier
authors.initials: O
authors.lastname: Marjollet
authors.forename: Pantéa
authors.initials: P
authors.lastname: Guyomarch
authors.forename: Florianne
authors.initials: F
authors.lastname: Robert
authors.forename: Cristophe
authors.initials: C
authors.lastname: Berger
authors.forename: Stéphane
authors.initials: S
authors.lastname: Guyomarch
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Navez
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Bertrand
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use*; D001842:Bone and Bones / Q000293:injuries*; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D006801:Humans; D007596:Joints / Q000293:injuries*; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000503:physiopathology*
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen