As a trainee emergency doctor, part of my work is to assess patients who come to the emergency department and determine the urgency of the care, diagnosis and treatment required. Most patients are prompted to come to the hospital emergency department because they are in pain – a subjective and multidimensional symptom which is not necessarily reflective of the severity of the case, but which can cause immense distress to the individual.
As part of an MSc in critical care, I therefore decided to focus on this subject in a study entitled The introduction of pain scoring at triage point – Effect on analgesia administration pattern in patients presenting with acute abdominal pain at the emergency department.
The study’s primary aims were threefold: (i) to determine the effect of a validated pain scoring (VPS) system on the door-to-analgesia time when treating patients with acute abdominal pain; (ii) to correlate vital parameters with pain scores, and (iii) to identify the type and form of analgesic most commonly used in the local hospital’s emergency department and its correlation with pain severity.
Pain scoring should be included as the fifth vital sign in the triaging process
Two hundred patients were included in a pre-test/post-test, two-month-long study. A hundred of the patients in the post-test phase were asked to rate their pain according to the visual analog scale (VAS) pain score. Patient demographics, vital parameters and time and type of analgesia administration were recorded in an appropriate data collection sheet.
Data analysis showed that introducing the VAS system increased awareness of pain, the analgesia administration became more frequent, and the tendency for higher pain scores to be treated more frequently prevailed. However, there was no significant change in the promptness of administering analgesia, with a non-significant increase (p = 0.999) in waiting time of 7.5 minutes. No correlation was elicited between vital parameters, namely pulse rate, blood pressure, level of consciousness, oxygen saturation and respiratory rate with correlation values.
The most common analgesic used proved to be paracetamol and its use did not vary with the introduction of the pain- scoring system.
The study showed that the introduction of a pain-scoring system has its beneficial effects on pain management in the accident and emergency department, adhering to the tenet of Lewis et al. (1994), that early and aggressive analgesia aimed at interrupting the pain cycle and reducing the discomfort of pain should be at the basis of all pain-management practices.
Pain scoring increases the propensity to offer analgesia, but not the promptness of its administration, suggesting that pain scoring should be included as the fifth vital sign in the triaging process, since vital parameters do not reflect the degree of pain.
The study helped me to deepen my understanding of pain management, as well as raise awareness locally as to the importance of introducing a validated pain-scoring system in our accident and emergency department.
This research work was partially funded by the Malta Government Scholarship Scheme (MGSS) 2011.
Carlo Refalo is a specialist in emergency medicine and doctor of medicine and surgery.