Impact of pain location, organ system and treating speciality on timely delivery of analgesia in emergency departments

Abstract

Objective: This retrospective, observational cohort study investigated whether the clinical features of a patient's pain, including anatomical location, organ system and likely treating speciality, impact on the delivery of analgesia within 30 min in EDs.

Methods: Data were obtained from 24 centres across Australia between April 2008 and March 2009. Principal outcome was delivery of analgesia within 30 min or less. Factors that might explain any differences were analysed, including anatomical location of the pain, likely treating speciality, organ system affected, age, sex, day and time of presentation, hospital location, documented pain score and triage category. Analysis was by the χ(2)-test for independence of proportions and multiple logistic regression. A P-value <0.05 was considered statistically significant.

Results: There were 4598 patients, of whom 2578 were male. The median age was 36 years (range 0-103). Both limb origin of pain (χ(2) = 46.1, P < 0.001) and documentation of a pain score (χ(2) = 48.6, P < 0.001) were strongly associated with delivery of analgesia within 30 min. Attending a rural ED was a significant risk factor for delayed analgesia (χ(2) = 12.5, P < 0.001). Burns patients (40.2%, 47 of 117, P < 0.001) and orthopaedic patients (26.1%, 259 of 992, P < 0.001) were much more likely to received analgesia within 30 min than the mean (19.5%, 896 of 4598).

Conclusions: Patients presenting with burns, orthopaedic conditions or with a limb location of pain are more likely to receive analgesia within 30 min in Australian EDs. Clinicians should be aware of possible trends in the delivery of timely analgesia to patients with pain.