title: PAin SoluTions In the Emergency Setting (PASTIES)--patient controlled analgesia versus routine care in emergency department patients with pain from traumatic injuries: randomised trial.
abstract: OBJECTIVE
  To determine whether patient controlled analgesia (PCA) is better than routine care in patients presenting to emergency departments with moderate to severe pain from traumatic injuries.
  
  
  METHODS
  Pragmatic, multicentre, parallel group, randomised controlled trial.
  
  
  METHODS
  Five English hospitals.
  
  
  METHODS
  200 adults (71% (n = 142) male), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe pain from traumatic injuries and were expected to be admitted to hospital for at least 12 hours.
  
  
  METHODS
  PCA (n = 99) or nurse titrated analgesia (treatment as usual; n = 101).
  
  
  METHODS
  The primary outcome was total pain experienced over the 12 hour study period, derived by standardised area under the curve (scaled from 0 to 100) of each participant's hourly pain scores, captured using a visual analogue scale. Pre-specified secondary outcomes included total morphine use, percentage of study period in moderate/severe pain, percentage of study period asleep, length of hospital stay, and satisfaction with pain management.
  
  
  RESULTS
  200 participants were included in the primary analyses. Mean total pain experienced was 47.2 (SD 21.9) for the treatment as usual group and 44.0 (24.0) for the PCA group. Adjusted analyses indicated slightly (but not statistically significantly) lower total pain experienced in the PCA group than in the routine care group (mean difference 2.7, 95% confidence interval -2.4 to 7.8). Participants allocated to PCA used more morphine in total than did participants in the treatment as usual group (mean 44.3 (23.2) v 27.2 (18.2) mg; mean difference 17.0, 11.3 to 22.7). PCA participants spent, on average, less time in moderate/severe pain (36.2% (31.0) v 44.1% (31.6)), but the difference was not statistically significant. A higher proportion of PCA participants reported being perfectly or very satisfied compared with the treatment as usual group (86% (78/91) v 76% (74/98)), but this was also not statistically significant.
  
  
  CONCLUSIONS
  PCA provided no statistically significant reduction in pain compared with routine care for emergency department patients with traumatic injuries. Trial registration European Clinical Trials Database EudraCT2011-000194-31; Current Controlled Trials ISRCTN25343280.
authors.affiliation: Derriford Hospital, Plymouth PL6 8DH, UK Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Medical Directorate, Birmingham, UK Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK jasonesmith@nhs.net.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Smith
authors.affiliation: Derriford Hospital, Plymouth PL6 8DH, UK Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Rockett
authors.affiliation: Centre for Biostatistics, Bioinformatics and Biomarkers, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK jasonesmith@nhs.net.
authors.forename: Siobhan Creanor
authors.initials: SC
authors.lastname: S
authors.affiliation: Derriford Hospital, Plymouth PL6 8DH, UK.
authors.forename: Rosalyn
authors.initials: R
authors.lastname: Squire
authors.affiliation: Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Hayward
authors.affiliation: NIHR Research Design Service - South West.
authors.forename: Paul
authors.initials: P
authors.lastname: Ewings
authors.affiliation: NIHR Research Design Service - South West.
authors.forename: Andy
authors.initials: A
authors.lastname: Barton
authors.affiliation: NIHR Research Design Service - South West.
authors.forename: Colin
authors.initials: C
authors.lastname: Pritchard
authors.affiliation: Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Eyre
authors.affiliation: Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Cocking
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult