Factors associated to unrelieved pain in a Morrocan Emergency Department.
BACKGROUND
In the light of the impact that pain has on patients, emergency department (ED) physicians need to be well versed in its management, particularly in its acute presentation. The goal of the present study was to evaluate the prevalence of unrelieved acute pain during ED stay in a Moroccan ED, and to identify risk factors of unrelieved pain.


METHODS
Prospective survey of patients admitted to the emergency department of Ibn Sina teaching university hospital in Rabat (Morocco). All patients with acute pain over a period of 10 days, 24 hours each day were included. From each patient, demographic and clinical data, pain characteristics, information concerning pain management, outcomes, and length of stay were collected. Pain intensity was evaluated both on arrival and before discharge using Numerical Rating Scale (NRS). Comparison between patient with relieved and unrelieved pain, and factors associated with unrelieved pain were analyzed using stepwise forward logistic regression.


RESULTS
Among 305 patients who complained of acute pain, we found high levels of intense to severe pain at ED arrival (91.1%). Pain intensity decreased at discharge (46.9%). Unrelieved pain was assessed in 24.3% of cases. Patients with unrelieved pain were frequently accompanied (82.4% vs 67.1%, p = 0.012), and more admitted daily than night (8 am-20 pm: 78.4% vs 64.9%; 21 pm-7 am: 21.6% vs 35.1%, p = 0.031), and complained chiefly of pain less requently (56.8% vs 78.8%, p<0.001). They had progressive pain (73% vs 44.2%, p<0.001), and had a longer duration of pain before ED arrival (72-168 h: 36.5% vs 16.9%; >168 h: 25.5% vs 17.7%, p<0.001). In multivariate analysis, predictor factors of unrelieved pain were: accompanied patients (OR = 2.72, 95% CI = 1.28- 5.76, p = 0.009), pain as chief complaint (OR = 2.32, 95% CI = 1,25-4.31, p = 0.007), cephalic site of pain (OR = 6.28, 95% CI = 2.26-17.46, p<0.001), duration of pain before admission more than 72 hours (72-168 h (OR = 7.85, 95% CI = 3.13-25.30, p = 0.001), and >168 h (OR = 4.55, 95% CI = 1.77-14.90, p = 0.02).


CONCLUSIONS
This study reported high levels of intense to severe pain at ED arrival. However, one quarter patients felt on discharge from the ED that their pain had not been relieved. The relief of pain in ED depend both sociodemographic, clinical, and pain characteristics factors.
Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco.
Maha
M
Louriz
Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco.
Jihane
J
Belayachi
Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco.
Bouchra
B
Armel
Medical Intensive Care Unit, Ibn Sina University Hospital, 10000 Rabat, Morocco.
Tarek
T
Dendane
Medical Intensive Care Unit, Ibn Sina University Hospital, 10000 Rabat, Morocco.
Khalid
K
Abidi
Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco.
Naoufel
N
Madani
Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco.
Aicha
A
Zekraoui
Surgical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco.
Abdellatif Belabes
AB
Benchekroun
Medical Intensive Care Unit, Ibn Sina University Hospital, 10000 Rabat, Morocco.
Amine Ali
AA
Zeggwagh
Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco ; Laboratory of Biostatistics, Clinical and Epidemiological Research, Faculté de Médecine et Pharmacie- Université Mohamed V Souissi, 10000 Rabat, Morocco.
Redouane
R
Abouqal
Emergency department; Pain; Pain relief; Unrelieved pain