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Original Contributions| Volume 50, ISSUE 1, P14-20, January 2016

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Impact of Age on Pain Perception for Typical Painful Diagnoses in the Emergency Department

  • Raoul Daoust
    Correspondence
    Reprint Address: Dr. Raoul Daoust, MD, MSc, Department of Emergency Medicine, Sacré-Coeur Hospital of Montréal, 5400 boul. Gouin ouest, Montréal, Quebec, Canada H4J 1C5
    Affiliations
    Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada

    Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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  • Jean Paquet
    Affiliations
    Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada

    Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
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  • Éric Piette
    Affiliations
    Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada

    Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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  • Karine Sanogo
    Affiliations
    Department of Emergency Medicine, Hôpital régional de St-Jérôme, St-Jérôme, Québec, Canada
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  • Benoit Bailey
    Affiliations
    Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada

    Division of Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec, Canada
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  • Jean-Marc Chauny
    Affiliations
    Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada

    Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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Published:September 23, 2015DOI:https://doi.org/10.1016/j.jemermed.2015.06.074

      Abstract

      Background

      Age-related differences in pain perception have been demonstrated in experimental settings but have been investigated scarcely and without valid scale in the clinical framework.

      Objectives

      To examine the effect of age on pain perception for recognized painful diagnoses encountered in the emergency department (ED).

      Methods

      A post-hoc analysis of real-time archived data was performed in a tertiary urban and a secondary regional ED. We included all consecutive adult patients (≥18 years) with the following diagnosis at discharge: renal colic, pancreatitis, appendicitis, headache/migraine, dislocation and extremities fractures, and a pain evaluation of ≥1 (0−10, verbal numerical scale) at triage. The primary outcome was to compare for each of these diagnoses the level of pain intensity between four age groups (18−44; 45−64; 65−74; 75+ years).

      Results

      A total of 15,670 patients (48% women) were triaged with a mean pain intensity of 7.7 (SD=2.0). Women exhibited greater pain scores than men for pancreatitis, headache/migraine, and extremity fracture. Renal colic, pancreatitis, appendicitis, and headache/migraine showed a linear decrease in pain scores with age whereas dislocation and extremity fractures did not present age differences. Mean differences in pain intensity scores between young adults (18−44 years) and patients aged ≥75 years were 0.79 (95% confidence interval [95% CI] 0.5−1.1) for renal colic, 1.1 (95% CI 0.7−1.4) for pancreatitis, 0.70 (95% CI 0.2−1.2) for appendicitis, and 0.86 (95% CI 0.6−1.1) for headache/migraine.

      Conclusion

      Older patients perceive similar pain for dislocation and extremity fractures and less for visceral and headache/migraine pain; however, these age differences may not be clinically important.

      Keywords

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