Analgesic treatment in patients with acute extremity trauma and effect of training

Abstract

Introduction: Studies indicate that emergency physicians (EP) underevaluated and undertreated pain their patients experienced. The objective of this study is to investigate how EPs treat pain in adult patients with limb teauma and if their behavior could be affected by training in the short term.

Methods: All consecutive adult patients admitted to the University-based emergency department (ED) within two months were enrolled to the study. The patients were asked to rate their level of pain on NRS in triage. NRS scores was noted again in 30th, 60th minutes and on discharge. Their prescriptions were also tracked regarding presence of analgesics. After completion of the pre-education phase, four hours of training covering the area were undertaken by experienced staff faculty. After the same sort of data were abstracted in another 30 days, comparisons between the periods were carried out.

Results: A hundred and forty-three patients (81 female) were enrolled in the pre-education phase while 130 (58 female) were eligible in the post-education phase. Mean NRS scores of females noted on admission were significantly higher than of males (7.4±2.3 vs. 6.7±2.5, respectively) (p=0.020). Patients included in the first phase received analgesia less frequently (42.7% vs. 70.0%, respectively) (p<0.001). Mean period passed between admission and the initial analgesic administration was shorter in the second phase (41.3 vs. 19.3 minutes, respectively) (p<0.001). The ratio of patients receiving analgesia within thirty minutes was greater after training. Concurrently, all patients in the second phase received analgesia within 60 minutes. The residents prescribed analgesics more frequently after training.

Conclusion: A four-hour training programme resulted in apparent changes in the residents’ management of pain in patients with extremity trauma. In addition to a more timely administration, the rates of analgesic treatment increased.