Pain Scores Improve Analgesic Administration Patterns for Trauma Patients in the Emergency Department

Background: Trauma, one of the major concerns in today’s world, exposes societies to important economic, social and health-related problems. Trauma is known to account for 10% of the world’s deaths. Objective: The aim of the study is to evaluate the demographic characteristics of trauma, which is common in emergency services and causes significant loss of workload and function when appropriate diagnosis and treatment methods are not applied, with radiological imaging methods, pain scale and analgesics. Materials and Methods: This prospective study included 1267 patients over the age of 18, who were admitted to the emergency department due to trauma between 1 January and 31 December 2019. The mean age of patients was 47.01 ± 14.97 year, with a male/female ratio of 1.46. 59.3% of the patients were male and 40.7% were female. Patients’ trauma types, radiology results, mortality, numerical pain scale and analgesic administration were evaluated. Results: Numerical pain scale score of trauma patients in the emergency department was 6.23 ± 2.02. Analysis of radiological imaging methods showed significance with age, numerical pain scale, thoracic and lumbar vertebrae, thoracic and abdominal injuries, types of trauma, consultation, hospitalization, analgesics administration and pain severity. Trauma types were insignificant with age and gender, but a significant relationship was found with all other parameters. Pain intensity was not correlated with gender and tetanus application but was significant with other variables. There was significance in radiological imaging methods and diagnostic types between injury types. Types of diagnosis were found to be correlated with imaging methods, orthopedic consultation, numerical pain scale and injury types. There was a significant correlation with the types of diagnosis, analgesia administration, consultation, and pain classification according to the pain rating scale. There was no correlation between age and gender according to pain intensity. However, there was a strong positive correlation with pain scale scores, consultation, hospitalization, types of trauma, administration of analgesia, and a weak correlation with radiological imaging methods. Conclusion: Early pain scale with radiological imaging and analgesic administration in trauma patients can reduce morbidity rates and shorten hospital stay.

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Assessment of the effectiveness of pain management among trauma patients in the emergency department

10.21203/rs.3.rs-78731/v1 ◽

2020 ◽

Author(s):

Ahmad Wazzan ◽

Yazeed Khalid Albeladi ◽

Rozan Ibrahim Altaifi ◽

Mohammed Saeed Alqahtani ◽

Rayan Mahmoud Bakheet

Keyword(s):

Emergency Department ◽

Pain Management ◽

Pain Scale ◽

Initial Assessment ◽

P Value ◽

Time Of Arrival ◽

Trauma Patients ◽

Pain Scores ◽

Before And After ◽

Numeric Pain Scale

Abstract Background:In the emergency department (ED), pain is the most common complaint, especially among trauma patients. However, two-thirds of trauma patients are discharged from EDs with moderate to severe pain. Therefore, pain management is an important part of care in ED's trauma patients.Aim:To assess the effectiveness of pain management among trauma patients in the ED.Method:A retrospective cohort study that was conducted on adult trauma patients who attended the ED at King Abdulaziz medical city (KAMC) in Jeddah from the period (June 2016 to July 2018). The pain was measured twice, one before the intervention and one after intervention using a numeric pain scale. Data were collected from health information system (Best care®) and analyzed using SPSS version 24.Results:The Mean difference between pain scores before and after pain management was one on a numeric pain scale with a P-Value 0.001. Initial pain assessment occurred only in 69% of our population, while assessment after intervention happened in 71% of patients. Patients who received appropriate medication were 36.7%. 35% of patients received opioids as an initial drug of pain management; only 8.8% of patients had pain scores more than 7 initially. The median between the time of arrival and the time of Initial Assessment is 19 mins.Conclusion:Pain management in ED needs improvement. Timeliness of pain management should be addressed. Evaluation and re-evaluation of pain before and after the intervention is insufficient. Trauma Patients don't receive effective pain management in the ED.

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Fentanyl-midazolam vs. midazolam-ketamine regarding patient sedation analgesia for emergency orthopedic procedures

Bangladesh Journal of Pharmacology ◽

10.3329/bjp.v12i2.30381 ◽

2017 ◽

Vol 12 (2) ◽

pp. 30

Author(s):

Ali Abdolrazaghnejad ◽

Mohsen Banaie

Keyword(s):

Emergency Department ◽

Adverse Effects ◽

Controlled Trial ◽

Orthopedic Procedures ◽

Trauma Patients ◽

Double Blind ◽

Emergency Procedures ◽

Pain Scores ◽

Level Of Satisfaction

<p class="Abstract">The aim of the present study was to investigate two pharmaceutical groups including fentanyl-midazolam and midazolam-ketamine used as patient seda-tion analgesia for the orthopedic emergency procedures. This is a prospective randomized double-blind and placebo-controlled trial study. Trauma patients admitted to emergency department who needed emergency reduction were enrolled. Finally 81 patients with mean age of 31.7 ± 20.6 years old were participated (64.2% male). It is likely that the combination of midazolam-ketamine had a better performance in terms of the duration of hypoxia (p=0.01), and pain scores during reduction (p=0.001). However, adverse effects were higher in the midazolam-ketamine group compared to the fentanyl-midazolam. The level of satisfaction of physicians and patients were the same.</p>

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Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

Canadian Association of Radiologists Journal ◽

10.1177/08465371211023861 ◽

2021 ◽

pp. 084653712110238

Author(s):

Francesco Macri ◽

Bonnie T. Niu ◽

Shannon Erdelyi ◽

John R. Mayo ◽

Faisal Khosa ◽

...

Keyword(s):

Emergency Department ◽

Major Trauma ◽

Patient Flow ◽

Interrupted Time Series ◽

Trauma Patients ◽

Linear Regression Models ◽

High Acuity ◽

Time Series Approach ◽

Comparison Series ◽

The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

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