Cecilia, Anthonysamy
(2008)
A randomised controlled trial
of the effect of displayed pain score
on analgesic administration
in adult trauma patients
at the emergency department
of Kuala Lumpur Hospital.
Masters thesis, Universiti Sains Malaysia.
Abstract
Pain is a common symptom experienced by trawna patients presenting to
emergency departments. Yet only 38% of patients evaluated for major trawna received
analgesic (Silka eta/., 2004). The management of pain is often regarded as less important
compared to arriving at diagnosis and treatment proper. Yet a physician's primary duty is
to comfort, manage and reduce the suffering of a patient. Documentation of patient's
pain score at triage has been recommended by JCAHO as a tool towards improving
pain management in the ED .
STUDY OBJECTIVE
The objective of this study was to determine the effect of documentation and
display of patients' self assessment of pain using numerical rating scale (NRS) on
analgesic use among adult trauma patients at the emergency department af Kuala
Lumpur Hospital.
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METHOD
A randomized control trial was conducted recruiting 200 trauma patients who
presented to the secondary triage and treated in the green zone of the emergency
department in Kuala Lumpur Hospital. Only patients who had GCS of 15/15 were
included. Convenient sampling was used. Pain score was done using NRS for all
patients. They were randomized to have the pain score either displayed prominently in
the trial group or not displayed in the control. Outcome measured were proportion of
patients receiving analgesic and timing from triage to analgesic administration.
RESULTS
The mean pain score was 5. 7. 15 % of patients had mild pain, 48 % had
moderate pain and 37% had severe pain. 26.5% (53) patients received analgesics. There
was no significant difference in the proportion of patients, 29.7 % receiving analgesic
when pain score was displayed, compared to 23.2 % when pain score was not displayed.
p value was 0.3 by chi-square test. Within the trial group, the severity of pain was
significantly associated with receiving analgesic (p = 0.007). Severity of pain did not
have a confounder effect on the association of displayed pain score and analgesic
administration. Mean time to receiving analgesic from triage was 81.3 minutes in the trial
sample compared to 88. 7 minutes in the control sample. There was no relationship
between pain score and the timing to analgesic.
Display of pain score in the absence of other multi-prong intervention can not be
enough to improve analgesic administration in emergency department.
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