Emergency Department Pain Management and Its Impact On Patients’ Short Term Outcome

Abstract: Background: Although pain is the most common complaint in the Emergency Department (ED), there is still a lack of adequate pain treatment by Emergency Physicians. Aim of this study was to describe pain management in ED from triage to discharge and to verify the effect of pain treatment in ED on a short term follow-up after discharge in order to evaluate patient’s outcome. Methods: A prospective multicentric study was conducted over two consecutive one week period in 4 ED teaching hospitals in Italy. All patients presenting with an acute, painful condition were eligible to participate in the study. The complete ED pain treatment was recorded, we enrolled 582 consecutive patients. One week after ED discharge a follow up evaluation through a phone call on patient’s pain clinical condition was also obtained. Results: There was a statistical significant difference between nurse and Emergency Physicians pain judgement (p<0.001). During ED visit: 54.2% received non steroid anti inflammatory drug (NSAID), 12.2% received paracetamol and 9.9% tramadol while morphine was used only in 5.6%of patients. Overall patient’s satisfaction at one-week follow-up was as follows: in 63% of patients pain was completely absent, but on the other hand, 37% of patients had no pain relief, despite analgesic therapy prescription. Conclusion: In our study we found differences between nurses and physicians judgments, they disagreed on the severity of pain. It was observed a low use of pain intensity scale with a formal measurement scales to assess pain. Our study demonstrates the importance of adequate ED and analgesic drug prescription for patients referring for pain in ED, and follow up assessment, many patients in follow up reported continued pain because of poor prescription of analgesic drug at discharge from ED. Improving analgesia in ED seems to be crucial for patients’ quality of life and for preventing ED readmission for relapse of pain.