Determinants of inappropriate acute pain management in old people unable to communicate verbally in the emergency department

Attilio Allione; Emanuele Pivetta; Elisa Pizzolato; Bartolomeo Lorenzati; Fulvio Pomero; Letizia Barutta; Giuseppe Lauria; Bruno Tartaglino

doi:10.1016/j.tjem.2017.08.001

Attilio Allione¹, Emanuele Pivetta², Elisa Pizzolato¹, Bartolomeo Lorenzati¹, Fulvio Pomero³, Letizia Barutta¹, Giuseppe Lauria¹, Bruno Tartaglino¹

¹Emergency Medicine Unit, S. Croce and Carle General Hospital, Cuneo, Italy
²Cancer Epidemiology Unit, CPO Piemonte, CeRMS, University of Turin, Italy
³Internal Medicine Unit, Santa Croce and Carle General Hospital, Cuneo, Italy

Keywords: Emergency department, Pain, Oligoanalgesia

Abstract

Objectives: Poor pain management is relevant among individuals unable to communicate verbally (UCV). Analgesia may be due to three determinants: patients' status, physician's characteristics and pain etiology. Our aim is to investigate the association between prescription of ED pain treatment and these determinants.

Materials and Methods: An observational prospective study including UCV patients was conducted. Severity of pain was evaluated by ALGOPLUS Scale and a score P ≥ 2 out of 5 on the pain scale was retained as the threshold for the presence of acute pain in elderly UCV patients.

Results: Our data showed that only 31,9% of UCV patients received a pharmacological treatment. The presence of the caregiver would influence the rate of therapy administration [OR 6,19 (95% CI 2,6–14,75)]. The presence of leg pain [OR 0,32 (95% CI 0,12–0,86)] and head pain [OR 0,29 (95% CI 0,10–0,84)] were less likely associated to receive analgesia. Pain related to trauma [OR 4.82 (95% CI 1.17 to 19.78)] and youngest physicians [OR 1.08 (95% CI 1.001 to 1.18)] were variables associated with the administration of drugs opiates.

Discussion: Older UCV patients presenting to the ED with pain are at high risk of inadequate analgesia. Providers should always suspect presence of pain and an increasing need for behavioural pain evaluation is necessary for a complete assessment.

Conclusions: Presence of a caregiver influences a more appropriate pain management in these patients. Staff training on pain management could result in better assessment, treatment, and interaction with caregivers.