title: Treatment of Acute Renal Colic in US and French EDs: Simulated Cases and Real Cases in Acute Pain Management.
abstract: OBJECTIVE
  To assess the prescribing patterns in acute renal colic in emergency departments in US and France, by comparing physicians' intended prescription practices with actual prescription data in a sample of emergency practitioners.
  
  
  METHODS
  Pharmaco-epidemiological international study in two phases. First, we surveyed emergency physicians in US and France as to what analgesics they would use for simulated cases of renal colic. We then conducted a retrospective review of actual cases of emergency department patients with pain scores ≥6/10 with acute renal colic during a period of 6 months before the survey. We compared nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids used for pain treatment in the two groups, and the differences between the two countries.
  
  
  RESULTS
  One hundred six prescribers and 100 patients were included in the study. Comparison between simulated and real cases showed that NSAIDs and opioids were less frequently prescribed in real life (78% vs 99% and 51% vs 100% respectively). Morphine was the most prescribed opioid (96% of simulated cases and 34% of real ones). Acetaminophen use was increased in real life cases (58% vs 0%). Concerning the differences between countries, US physicians are more likely to administer morphine (64% vs 38%) and French physicians NSAIDs (88% vs 68%). The NSAIDs used are ketorolac in the United States (94% of simulated cases vs 64%) and ketoprofen in France (94% and 88% respectively).
  
  
  CONCLUSIONS
  We showed clear differences between intended and real analgesic prescription practices for patients suffering from renal colic. Some differences exist for pain perceptions and treatments between US and France.
authors.affiliation: Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France; Unité de Recherche de Pharmacoépidémiologie, INSERM UMR 1027 Toulouse, France. Electronic address: bounes.v@chu-toulouse.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bounes
authors.affiliation: Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Vallé
authors.affiliation: Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France.
authors.forename: François
authors.initials: F
authors.lastname: Concina
authors.affiliation: Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Lauque
authors.affiliation: Pôle Médecine d'Urgence, Hôpital Universitaire de Purpan, Toulouse 31059, Cedex 9, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Ducassé
authors.affiliation: Department of Emergency Medicine Administrative Offices, West CC-2, Beth Israel Deaconess Medical Center, 1 Deaconess Place, Boston, MA 02215, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Edlow
mesh_terms: D059787:Acute Pain / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D056844:Renal Colic / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal