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Longitudinal Trends in the Treatment of Abdominal Pain in an Academic Emergency Department

      Abstract

      Background

      Abdominal pain is a top chief complaint of patients presenting to Emergency Departments (ED). Historically, uncertainty surrounded correct management. Evidence has shown adequate analgesia does not obscure the diagnosis, making it the standard of care.

      Objective

      We sought to evaluate trends in treatment of abdominal pain in an academic ED during a 10-year period.

      Methods

      We prospectively evaluated a convenience sample of patients in an urban academic tertiary care hospital ED from September 2000 through April 2010. Adult patients presenting with a chief complaint of abdominal pain were included in this study. Analgesic administration rates and times, pain scores, and patient satisfaction at discharge were analyzed to evaluate trends by year.

      Results

      There were 2,646 patients presenting with abdominal pain who were enrolled during the study period. Rates of analgesic administration generally increased each year from 39.9% in 2000 to 65.5% in 2010 (p value for trend <0.001). Similarly, time to analgesic administration generally decreased by year, from 116 min in 2000 to 81 min in 2009 (p < 0.001). There was no improvement in mean pain scores at discharge by year (p = 0.27) and 48% of patients during the 10-year period still reported moderate to severe pain at discharge. Patient satisfaction with pain treatment increased from a score of 7.1 to 9.0 during the study period (p < 0.005), following the trend of increase in analgesic administration.

      Conclusions

      In patients presenting to the ED with abdominal pain, analgesia administration increased and time to medication decreased during the 10-year period. Despite overall improvements in satisfaction, significant numbers of patients presenting with abdominal pain still reported moderate to severe pain at discharge.

      Keywords

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      References

        • Pitts S.R.
        • Niska R.W.
        • Xu J.
        • et al.
        National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary.
        Natl Health Stat Report. 2008; 7: 1-38
        • Bhuiya F.A.
        • Pitts S.R.
        • McCaig L.F.
        Emergency department visits for chest pain and abdominal pain: United States, 1999-2008.
        NCHS Data Brief. 2010; 43: 1-8
        • Manterola C.
        • Vial M.
        • Moraga J.
        • Astudillo P.
        Analgesia in patients with acute abdominal pain.
        Cochrane Database of Systematic Reviews [serial on the Internet]. 2011; (Available from:)
      1. Clinical policy: critical issues for the initial evaluation and management of patients presenting with a chief complaint of nontraumatic acute abdominal pain.
        Ann Emerg Med. 2000; 36: 406-415
        • Fosnocht D.E.
        • Swanson E.R.
        • Barton E.D.
        Changing attitudes about pain and pain control in emergency medicine.
        Emerg Med Clin North Am. 2005; 23: 297-306
        • Hashikawa C.
        • Burke T.F.
        • Pallin D.J.
        • et al.
        Analgesia administration for acute abdominal pain: a survey of emergency physicians.
        Ann Emerg Med. 2007; 50: 91-92
        • Wolfe J.M.
        • Lein D.Y.
        • Lenkoski K.
        • et al.
        Analgesic administration to patients with an acute abdomen: a survey of emergency medicine physicians.
        Am J Emerg Med. 2000; 18: 250-253
        • Todd K.H.
        • Ducharme J.
        • Choiniere M.
        • et al.
        Pain in the emergency department: results of the Pain and Emergency Medicine Initiative (PEMI) Multicenter Study.
        J Pain. 2007; 8: 460-466
        • Rupp T.
        • Delaney K.A.
        Inadequate analgesia in emergency medicine.
        Ann Emerg Med. 2004; 43: 494-503
        • Knopp R.K.
        • Dries D.
        Analgesia in acute abdominal pain: what's next?.
        Ann Emerg Med. 2006; 48: 161-163
        • Motov S.M.
        • Khan A.N.
        Problems and barriers of pain management in the emergency department: are we ever going to get better?.
        J Pain Res. 2008; 2: 5-11
        • Allione A.
        • Melchio R.
        • Martini G.
        • et al.
        Factors influencing desired and received analgesia in emergency department.
        Intern Emerg Med. 2011; 6: 69-78
        • Kim M.K.
        • Galustyan S.
        • Sato T.T.
        • et al.
        Analgesia for children with acute abdominal pain: a survey of pediatric emergency physicians and pediatric surgeons.
        Pediatrics. 2003; 112: 1122-1126
      2. ACEP Compendium. 2011. Available at: http://www.acep.org. Accessed May 10, 2011.

        • Mills A.M.
        • Shofer F.S.
        • Chen E.H.
        • et al.
        The association between emergency department crowding and analgesia administration in acute abdominal pain patients.
        Acad Emerg Med. 2009; 16: 603-608
        • Tanabe P.
        • Buschmann M.
        A prospective study of ED pain management practices and the patient's perspective.
        J Emerg Nurs. 1999; 25: 171-177
        • Graber M.A.
        • Ely J.W.
        • Clarke S.
        • et al.
        Informed consent and general surgeons' attitudes toward the use of pain medication in the acute abdomen.
        Am J Emerg Med. 1999; 17: 113-116
        • Lee J.
        • Kirschner J.
        • Pawa S.
        • et al.
        Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007.
        Ann Emerg Med. 2010; 56: 591-596
        • Rosengren D.
        • Brown A.F.
        • Chu K.
        Radiological imaging to improve the emergency department diagnosis of acute appendicitis.
        Emerg Med Australas. 2004; 16: 410-416
        • Blank F.S.
        • Mader T.J.
        • Wolfe J.
        • et al.
        Adequacy of pain assessment and pain relief and correlation of patient satisfaction in 68 ED fast-track patients.
        J Emerg Nurs. 2001; 27: 327-334
        • Stahmer S.A.
        • Shofer F.S.
        • Marino A.
        • et al.
        Do quantitative changes in pain intensity correlate with pain relief and satisfaction?.
        Acad Emerg Med. 1998; 5: 851-857
        • Thompson D.A.
        • Yarnold P.R.
        Relating patient satisfaction to waiting time perceptions and expectations: the disconfirmation paradigm.
        Acad Emerg Med. 1995; 2: 1057-1062
        • Bursch B.
        • Beezy J.
        • Shaw R.
        Emergency department satisfaction: what matters most?.
        Ann Emerg Med. 1993; 22: 586-591
        • Ward S.E.
        • Gordon D.B.
        Patient satisfaction and pain severity as outcomes in pain management: a longitudinal view of one setting's experience.
        J Pain Symptom Manage. 1996; 11: 242-251