Impact of pain location, organ system and treating speciality on timely delivery of analgesia in emergency departments.
OBJECTIVE
This retrospective, observational cohort study investigated whether the clinical features of a patient's pain, including anatomical location, organ system and likely treating speciality, impact on the delivery of analgesia within 30 min in EDs.


METHODS
Data were obtained from 24 centres across Australia between April 2008 and March 2009. Principal outcome was delivery of analgesia within 30 min or less. Factors that might explain any differences were analysed, including anatomical location of the pain, likely treating speciality, organ system affected, age, sex, day and time of presentation, hospital location, documented pain score and triage category. Analysis was by the χ(2)-test for independence of proportions and multiple logistic regression. A P-value <0.05 was considered statistically significant.


RESULTS
There were 4598 patients, of whom 2578 were male. The median age was 36 years (range 0-103). Both limb origin of pain (χ(2) = 46.1, P < 0.001) and documentation of a pain score (χ(2) = 48.6, P < 0.001) were strongly associated with delivery of analgesia within 30 min. Attending a rural ED was a significant risk factor for delayed analgesia (χ(2) = 12.5, P < 0.001). Burns patients (40.2%, 47 of 117, P < 0.001) and orthopaedic patients (26.1%, 259 of 992, P < 0.001) were much more likely to received analgesia within 30 min than the mean (19.5%, 896 of 4598).


CONCLUSIONS
Patients presenting with burns, orthopaedic conditions or with a limb location of pain are more likely to receive analgesia within 30 min in Australian EDs. Clinicians should be aware of possible trends in the delivery of timely analgesia to patients with pain.
Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia. hansenke@gmail.com
Kim
K
Hansen
Ogilvie
O
Thom
Hamish
H
Rodda
Melanie
M
Price
Chris
C
Jackson
Scott
S
Bennetts
Steven
S
Doherty
Harry
H
Bartlett
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D001315:Australia; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000188:drug therapy* / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult
D000700:Analgesics