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Pain in the ED: does anyone manage it well?
  1. Sarah Wilson1,
  2. Jack Dainty2,
  3. Jane Quinlan3,
  4. Fiona C Sampson4,
  5. David Metcalfe1,5,
  6. Liza Keating6
  1. 1 Emergency Department, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
  2. 2 University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
  3. 3 Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
  4. 4 ScHARR, The University of Sheffield, Sheffield, UK
  5. 5 Oxford Trauma and Emergency Care (OxTEC), Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
  6. 6 Emergency Department & Intensive Care Unit, Royal Berkshire NHS Foundation Trust, Reading, UK
  1. Correspondence to Dr Sarah Wilson, Emergency Department, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK; sarah.wilson2{at}

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Most patients presenting to the ED are in pain but previous work from the UK has shown that this is often not asked about, recorded or treated effectively.1 The Royal College of Emergency Medicine (RCEM) Best Practice Guidelines (BPGs) on Management of Pain in Adults2 and Children3 advocate recording a pain score, delivering timely and adequate analgesia, then assessing the response. These guidelines recognise that pain management in the ED can be challenging and identify key barriers to the effective delivery of analgesia in the ED.4 Based on previous work1 5 6 that showed significant variation in pain management between EDs, this study aimed to identify EDs that perform consistently well in the management of pain so that others could learn from positive outliers.


The study was a secondary analysis of national RCEM data from audits reporting pain-related outcomes (hip fracture and pain in children) in two time periods. UK …

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  • Handling editor Edward Carlton

  • X @fcsampson, @TraumaDataDoc, @LizaKeating

  • Contributors LK, SW and JQ conceived the project. All authors contributed to the grant application and study design. JD performed the data cleaning and analysis. All authors contributed to interpretation of the data. SW and LK drafted the manuscript. All authors critically reviewed and approved the final version of the manuscript.

  • Funding This study was funded by the Royal College of Emergency Medicine.

  • Competing interests The RCEM grant supported JD for statistical input to this project. There are no other competing interests to declare.

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

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