Risk evaluation with pain score for clinical assessment & management of pain in emergency department in a tertiary care hospital

Introduction: Acute pain is a complex process where there is release of chemical mediators as an inflammatory response, stimulating the different nociceptors of the affected area.[1] Acute pain is a common presentation amongst patients visiting the emergency department, and its assessment and management should be a priority. Pain assessment should be done during triage and to be continued along with treatment throughout its stay in the emergency department. Management of pain improves patient’s clinical outcome.[1] Pain management by medications done in the emergency department targets the pain pathway via different mechanisms, aimed at reducing or eliminating the sensation of pain.In Numeric Rating Scale, on a scale from 0 to 10 where 0 means no pain & a score of 10 denotes worst pain, the patients in ER are asked to score their pain intensity which requires some abstract thinking by the patient themselves.[3] Other prominent pain assessment methods which can be used, the Visual Analogue Scale, McGill Pain Questionnaire, Health Assessment Questionnaire, Brief Pain Inventory, and PROMIS.[4] Aims and Objectives: To review different methods of analgesia used, the opioid prescribing practices, evaluation of patient satisfaction and to make the necessary changes and perform the corrective actions to achieve compliance in an emergency department at a tertiary care hospital. Methodology: Questionnaire - based study done in the ER. Results: There was a significant association of Type of pain medication across the triage category. It is probable that greater proportion of analgesics have been used in the green zone of ER. The time to resolve pain followed a normal distribution, hence the One Way ANOVA has been used for the analysis. There was no significant difference in the mean-time to resolve pain across the different age groups. Also, there was no significant difference in the mean-time to resolve pain across the different type of pain. The time to resolve pain followed a normal distribution pattern. There was no significant difference in the mean type of Pain Medication across the time to resolve pain. Conclusion: Musculoskeletal pain was the most common type of pain amongst the patients enrolled. Patients were mostly allocated in the green zone of triage in the ER indicating the risk category. The most common age group was 30 – 50 years, The audit revealed that the most commonly prescribed medication for pain management was analgesics.