Original Contributions
Pain Scores among Emergency Department (ED) Patients: Comparison by ED Diagnosis

https://doi.org/10.1016/j.jemermed.2012.05.002Get rights and content

Abstract

Background

Treatment for pain and pain-related conditions has been identified as the most common reason for Emergency Department (ED) visits.

Objective

This study was undertaken to characterize the distribution of self-reported pain scores for common ED diagnoses.

Methods

In this retrospective exploratory chart review, eligible participants included all adult ED patients age 18 years and over, with a self-reported triage pain score of 1 or higher during January–June 2011. Data were collected from ED electronic medical records.

Results

Among 1229 patients, the mean age was 44 years; 56% of patients were female, and 59% were white. The mean triage pain score for all patients was 7.1 (interquartile range 6–9). The most common reported diagnoses included: minor injuries (10%), abdominal pain (8%), and respiratory infections (8%). The diagnoses with the highest mean pain scores were: sickle cell crisis (mean pain score 8.7), back/neck/shoulder pain (8.5), and headache/migraine (8.3). Higher pain scores were significantly correlated with younger age (p < 0.001) and number of ED visits (p < 0.001). Demographic factors including female gender, African American race, and Medicaid insurance reported significantly higher pain scores (p < 0.001). Patients with multiple ED visits in the recent 12 months reported significantly higher pain scores (p < 0.001).

Conclusion

ED patients report a wide variety of pain scores. Factors associated with higher pain scores included younger age, female gender, African American race, Medicaid insurance status, multiple ED visits in the past year, and ED diagnoses of sickle cell crisis, back/neck/shoulder pain, and headache.

Introduction

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.

Section snippets

Study Design and Setting

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.

Selection of Participants

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

Characteristics of Study Subjects

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).

Main Results

The most common reported diagnoses were: minor injuries (10%), abdominal pain (8%), and respiratory

Discussion

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

Conclusion

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.

Article Summary

1. Why is this topic important?

  1. Pain is the most common complaint among ED patients. Assessment and management of pain is an essential component of

Acknowledgment

The authors wish to thank Nancy Buderer, ms, for her expertise in statistical analysis.

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