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Pain induced by investigations and procedures commonly administered to older adults in the emergency department: a prospective cohort study
  1. Laurence Baril1,
  2. Elisabeth Nguyen1,
  3. Lauralee Dufresne-Santerre1,
  4. Virginie Émond1,
  5. Marcel Émond1,2,
  6. Simon Berthelot2,3,
  7. Ann-Pier Gagnon3,
  8. Alexandra Nadeau3,4,
  9. Pierre-Hugues Carmichael4,
  10. Eric Mercier1,4
  1. 1 Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
  2. 2 Emergency Department, CHU de Québec – Université Laval, Quebec City, Quebec, Canada
  3. 3 Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie – Urgences – Soins Intensifs, Centre de recherche du CHU de Québec – Université Laval, Quebec City, Quebec, Canada
  4. 4 VITAM - Centre de recherche en santé durable de l'Université Laval, Quebec City, Quebec, Canada
  1. Correspondence to Dr Eric Mercier, Faculty of Medicine, Université Laval, Quebec, QC G1V 0A6, Canada; eric.mercier.2{at}


Background This study aimed to assess the level of pain induced by common interventions performed in older adults consulting to the ED.

Methods We conducted a prospective multicentre observational cohort study in two academic EDs (Quebec City, Canada) between June 2018 and December 2019. A convenience sample of well-oriented and haemodynamically stable older adults (≥65 years old) who underwent at least two interventions during their ED stay was recruited. The level of pain was assessed using an 11-point Numerous Rating Scale (NRS) and is presented using median and IQR or categorised as no pain (0), mild (1–3), moderate (4–6) or severe pain (7–10).

Results A total of 318 patients were included. The mean age was 77.8±8.0 years old and 54.4% were female . The number of pain assessments per intervention ranged between 22 (urinary catheterisation) and 240 (intravenous catheter). All imaging investigations (X-rays, CT and bedside ultrasound) were associated with a median level of pain of 0. The median level of pain for other interventions was as follows: blood samplings (n=231, NRS 1 (IQR 0–3)), intravenous catheters (n=240, NRS 2 (IQR 0–4)), urinary catheterisations (n=22, NRS 4.5 (IQR 2–6)), cervical collars (n=50, NRS 5 (IQR 0–8)) and immobilisation mattresses (n=34, NRS 5 (IQR 0–8)). Urinary catheterisations (63.8%), cervical collars (56.0%) and immobilisation mattresses (52.9%) frequently induced moderate or severe pain.

Conclusions Most interventions administered to older adults in the ED are associated with no or low pain intensity. However, urinary catheterisation and spinal motion restriction devices are frequently associated with moderate or severe pain.

  • emergency department
  • geriatrics
  • pain management

Data availability statement

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Data availability statement

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  • Handling editor Richard Body

  • Twitter @simon_berthelot

  • Contributors EM designed the study, with the help of EN, ME, SB and A-PG. EM, N-PG and A-PG developed the interview questionnaire with input from the other authors. EN, VE and LD-S conducted patient enrolment, under the supervision of AN, A-PG and EM. LB, EN, VE and LD-S performed the data collection. P-HC performed the statistical analysis. LB, AN and EM drafted the manuscript, and all authors critically reviewed and approved the manuscript. EM takes responsibility for the paper as a whole.

  • Funding This project was funded by the FRE/FCSAA from the Département de médecine familiale et médecine d'urgence de la Faculté de médecine de l'Université Laval (no grant number allocated). This sponsor played no role in the design or in the conduct of this study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.