Senior patients with moderate to severe pain wait longer for analgesic medication in EDs.
OBJECTIVE
Delayed pain treatment is a common problem in emergency departments (EDs). The objective of this study was to examine the effect of age on time to ED patients receiving the first analgesic dose for moderate to severe pain.


METHODS
Real-time, archived data from a tertiary urban hospital and a secondary regional hospital were analyzed post hoc. We included all consecutive adult ED patients (≥ 18 years) on stretchers whose pain intensity was at least 4 (0-10, verbal numerical scale) at triage between March 2008 and December 2012. The primary outcome was time from the beginning of triage to analgesic medication in seniors (≥ 65 years) compared with younger patients.


RESULTS
A total of 34,213 patients (56% women) were triaged to an ED bed with mean pain intensity of 7.6 (SD ± 1.8). Analgesics were administered to 20,486 patients (59.9%) in a median time of 2.3 hours (interquartile range [IQR] = 3.6). Median time for seniors to receive analgesics was 3.2 hours (IQR = 5.1) compared with 2.1 hours (IQR = 3.1, effect size = 0.19) for younger patients. This represents a 55.2% increase in time to analgesic for seniors. Seniors waited 12 minutes longer to be evaluated by a physician, 20 minutes longer for analgesic prescription, and 35 minutes longer for medication administration. After controlling for confounding factors, they still waited longer to receive pain medication (hazards ratio = 1.37; 95% confidence interval, 1.32-1.42) than younger patients.


CONCLUSIONS
Seniors with moderate to severe pain wait 1.1 hours (55.2%) longer than younger patients to receive analgesics. Physicians and nurses (32 and 35 minutes, respectively) contributed to this disparity.
Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada. Electronic address: raoul.daoust@videotron.ca.
Raoul
R
Daoust
Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada; Center for Advanced Research in Sleep Medicine and Department of Surgery, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada.
Jean
J
Paquet
Faculties of Dental Medicine and Medicine, Université de Montréal, Montreal, Quebec, Canada; Center for Advanced Research in Sleep Medicine and Department of Surgery, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada.
Gilles
G
Lavigne
Department of Emergency Medicine, Hôpital St-Jérôme, St-Jérome, Quebec, Canada.
Karine
K
Sanogo
Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Jean-Marc
JM
Chauny
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D013997:Time Factors; D014218:Triage
D000700:Analgesics