Analgesic Treatment in Patients With Acute Extremity Trauma and Effect of Training

Objectives Studies indicate that emergency physicians (EP) under-evaluate and undertreat the pain experienced by their patients. The objective of this study was to investigate how EPs treat pain in adult patients with limb trauma and to determine 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 in the study. The patients were asked to rate their level of pain on the NRS in triage. NRS scores were noted again after 30 minutes and 60 minutes, and on discharge. Patient prescriptions were also tracked to identify any analgesics. After completion of the pre-education phase, four hours of training on pain evaluation and treatment were undertaken under the leadership of experienced staff faculty. The aforementioned outcomes were gathered again in a 30-day period after training and we compared the pre and post training periods. Results A hundred and forty-three patients (81 female) were enrolled in the pre-education phase, and 130 patients (58 female) were eligible for the post-education phase. The mean NRS scores of the females noted on admission were significantly higher than those of the 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). The mean period of time between admission and 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. All patients in the second phase received analgesia within 60 minutes. The residents prescribed analgesics more frequently after training. Conclusions A four- hour training program 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.