Analgesic Practice for Acute Orthopedic Trauma Pain in Costa Rican Emergency Departments

doi:10.1016/S0196-0644(96)70054-9

Annals of Emergency Medicine

Volume 28, Issue 2, August 1996, Pages 145-150

https://doi.org/10.1016/S0196-0644(96)70054-9 Get rights and content

Abstract

Study objective: Studies in US emergency departments have demonstrated that pain is undertreated in adults and children. Previous studies have also demonstrated cultural differences in the expression and perception of pain. The objective of this investigation was to describe the analgesic practices and patient pain responses in two Costa Rican EDs in light of possible differences due to cultural variation. Methods: We carried out a prospective, noninterventional observational assessment protocol of a convenience sample of patients being treated for orthopedic trauma in two university-affiliated urban teaching hospital EDs. Children between the ages of 5 and 12 years and all adults, ages 16 to 63, who presented with painful orthopedic trauma were included. Patients quantified their pain on arriving at and before leaving the ED. Children used a Face Interval Scale ranging from 1 (no pain) to 9 (maximum pain), and adults used a numeric rating scale ranging from 0 to 10. Results: One fourth of pediatric and more than half of all adult patients had no reduction in their pain scores on leaving the ED. Eleven percent of adults and fewer than 4% of children received pain treatment while in the ED. Fewer than half of all patients were sent home with analgesics. We observed no use of opioids in the ED for analgesia. Conclusion: Our data illustrate that both adults and children with severe pain resulting from orthopedic injury in the Costa Rican EDs we studied often receive inadequate or no analgesic treatment. This finding suggests that the phenomenon of oligoanalgesia is more widespread and resistant to cultural differences. We also noted a reluctance to use opioids in this setting. [Jantos TJ, Paris PM, Menegazzi JJ, Yealy DM: Analgesic practice for acute orthopedic trauma pain in Costa Rican emergency departments. Ann Emerg Med August 1996;28:145-150.]

Section snippets

INTRODUCTION

Although an array of analgesic options exist for the treatment of acute pain, both adults and children frequently receive suboptimal interventions.1, 2, 3, 4, 5, 6, 7, 8 Studies in North America have documented that patients often receive no analgesia for painful conditions and that they experience delays in receiving analgesia or receive inadequate doses of appropriate medications.1, 2, 3, 4, 5, 6 This phenomenon appears across many settings, including medical and surgical inpatient units,

MATERIALS AND METHODS

We carried out a prospective, observational clinical assessment of a convenience sample of patients being treated for acute orthopedic trauma in Costa Rica. San Jose is the capital of the Central American country; it lies in the central valley of the nation and has a population of almost 2 million. The San Jose region is served by four major tertiary care centers with a total of more than 2,800 beds.¹¹ Two of these hospitals were study sites: Hospital de Niños, the only specialized children's

RESULTS

Although 207 patients met the eligibility requirements, 50 were subsequently eliminated, 48 because pain scores were not recorded for a variety of logistic reasons (eg, the patient was triaged directly to a treatment area or the patient left the hospital before the discharge pain level could be assessed) and 2 because they responded while being influenced by an accompanying individual. This left 157 patients for whom diagnoses, pain-management therapies, and presenting and discharge pain-scale

DISCUSSION

Our investigation has again demonstrated poor analgesic practices with regard to pain, suggesting that this phenomenon is not culturally isolated. Pediatric and adult patients who presented to these two Costa Rican hospitals for acute orthopedic pain rarely received analgesics in the ED. Moreover, many adults and most children were not prescribed analgesics for home therapy. Although we did not measure patient satisfaction, our data demonstrate that patients were experiencing pain before and

Acknowledgements

The authors thank Kenneth Jacobs and Monica Ferguson for their invaluable contributions during data collection and Dr Norma Ceciliano and Dr Juan Corrales Soto for coordinating their activities in Costa Rica.

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^☆: From the Department of Emergency Medicine, University of Pittsburgh School of Medicine, and the Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, Pennsylvania.

^☆☆: Funding by the University of Pittsburgh School of Medicine and the Center for Emergency Medicine of Western Pennsylvania.

^★: Reprint address: Paul M Paris, MD, Center for Emergency Medicine of Western Pennsylvania, 230 McKee Place, Suite 500, Pittsburgh, Pennsylvania 15213

^★★: Reprint no. 47/1/74143

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Analgesic Practice for Acute Orthopedic Trauma Pain in Costa Rican Emergency Departments☆,☆☆,★,★★

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

Acknowledgements

Am J Emerg Med

Pain

Pain

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Analysis of narcotic usage in the treatment of postoperative pain

JAMA

Undertreatment of medical patients with narcotic analgesics

Ann Intern Med

Are emergency physicians too stingy with analgesics?

South Med J