Analgesic efficacy of orodispersible paracetamol in patients admitted to the emergency department with an osteoarticular injury.
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.
Viallon
Alain
A
Emergency and Intensive Care Units, Bellevue Hospital, Saint-Etienne, France. alain.viallon@univ-st-etienne.fr
Marjollet
Olivier
O
Guyomarch
Pantéa
P
Robert
Florianne
F
Berger
Cristophe
C
Guyomarch
Stéphane
S
Navez
Marie Louise
ML
Bertrand
Jean-Claude
JC
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*
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen