Objectives & Background Patients with dementia and traumatic injury require prompt and adequate pain relief. However we hypothesised that they may be at risk of under-treatment with analgesia in the emergency setting.

Methods We identified patients over 70 who attended our ED with acute musculoskeletal injuries and were either referred to the Orthopaedics/Trauma surgeons on call or the fracture clinic. Using clinical records and discharge diagnosis coding, 61 injured patients with dementia were identified. 84 injured patients over 70 without dementia were also studied. Their ED prescription records were examined and whether analgesia was given or not, together with the time interval from arrival to administration of first analgesic was noted. Kaplan-Meier curves were constructed from the time-interval data. Significance testing was by the log rank test.

Results 62% of the patients with dementia had acute fractures. 77% of controls had acute fractures. The remaining patients (21% overall) had soft tissue injuries or joint dislocations. 50% of injured patients with dementia received analgesia in the ED phase of their care, compared with 56% of controls. There was a trend to delayed administration of analgesia to patients with dementia compared to controls (p=0.074, log rank). (Figure 1 for Kaplan-Meier curves).

Conclusion Our findings suggest that injured patients with dementia are less likely to receive timely analgesia in the ED than patients without dementia. Further work is needed to identify the reasons behind this inequity and intervene accordingly.⇓

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Abstract 022 Figure 1

Kaplan-Meier plot of time interval from ED arrival to first analgesic; patients with dementia (upper curve) vs. controls (lower curve); p=0.074.