Article Summary
1. Why is this topic important? Pain is the most common complaint among ED patients. Assessment and management of pain is an essential component of
Pain has been identified as one of the most common reasons for Emergency Department (ED) visits (1). Effective pain management in the ED leads to improved patient satisfaction, reduced anxiety, and improved comfort 2, 3. Pain relief should be one of the priorities of emergency medical care, to better serve patients and build trust in the medical profession.
The verbal numeric rating scale is commonly used to assess pain by self-report in EDs. Previous studies have demonstrated that both verbal numeric rating scales and visual analog scales are valid methods of measurement of self-reported pain 4, 5, 6.
ED patients report variable levels of pain, even with similar types of diagnoses or injuries 7, 8. Previous studies have demonstrated that levels of perceived pain are associated with age, gender, depression, and anxiety 9, 10, 11.
This study was undertaken to characterize the distribution of self-reported pain scores among common ED diagnoses.
This study was a retrospective exploratory chart review conducted at the University of Toledo Medical Center, an urban university hospital ED with an annual patient census of 34,000. The University of Toledo Institutional Review Board approved this study.
Eligible participants included all adult ED patients age 18 years and over with a self-reported triage pain score of 1 or higher who visited the University of Toledo ED during January through June 2011. Exclusion criteria included patients
The study protocol was completed for 1229 patients (Table 1). Age of patients ranged from 18 to 90 years, with a mean of 43.7 years. Fifty-six percent (56%) of patients were female, 58% were Caucasian, 28% had Medicaid insurance, and 27% had Medicare insurance. Seventeen percent of patients were uninsured. The mean triage pain score for all patients was 7.1 (interquartile range 6–9) (Table 2).
The most common reported diagnoses were: minor injuries (10%), abdominal pain (8%), and respiratory
Pain is the most common reason for ED visits in the United States (12). Pain management is an important goal of effective emergency medical care (13). Despite recognition of its importance, unfortunately, numerous studies have documented inadequate pain management among ED patients 14, 15, 16, 17, 18, 19, 20.
Pain is typically assessed in the ED by self-report from the patient 21, 22. Self-reports are important, as previous studies have demonstrated that clinicians' perception of patients' pain
ED patients report a wide variety of pain scores. Demographic factors including younger age, female gender, African American race, Medicaid insurance status, and multiple ED visits in the past year were associated with higher self-reported pain scores. Higher pain scores were reported among patients with ED diagnoses of sickle cell crisis, back/neck/shoulder pain, and headache. 1. Why is this topic important? Pain is the most common complaint among ED patients. Assessment and management of pain is an essential component ofArticle Summary
The authors wish to thank Nancy Buderer, ms, for her expertise in statistical analysis.
LBP is one of the top reporting reasons for seeking care at EDs in the USA, with nearly four million admissions per year.31 Usually, when patients with LBP come to the ED they report relatively high pain intensity32 and only 5% present serious spinal pathologies and truly need urgent medical care.33 A number of evidence-based guidelines and models of care have been developed to improve LBP care worldwide.21,22,27,33–37
For pain severity, univariate and multivariate logistic regression analyses were done to assess for a relationship between pain severity and the diagnosis of acute MI or MACE within 6 weeks. As prior data on pain scores have disclosed that women [15,16], African Americans [15], and those of younger age [15,16] tend to report higher pain scores, gender, race, and age were used as control variables. For all multivariate analyses, we performed some model diagnostics.