Pain management practices in the emergency departments in Turkey
Murat Cetin1*, Bora Kaya2, Turgay Yilmaz Kilic3, Nazife Didem Hanoğlu4, Şervan Gökhan5, Serkan Emre Eroğlu6, Sakine Neval Akar7, Ozgen Gonenc Cekic8, Dicle Polat9, Emre Üstsoy10, Orhan Çınar11, Serkan Yilmaz12
1Department of First Aid and Emergency, Vocational School, İzmir Tınaztepe University, Izmir, Turkey
2Department of Emergency Medicine, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
3Department of Emergency Medicine, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
4Department of Emergency Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
5Department of Emergency Medicine, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
6Department of Emergency Medicine, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
7Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
8Department of Emergency Medicine, Faculty of Medicine, Trabzon Kanuni Education and Research Hospital, University of Health Science, Trabzon, Turkey
9Department of Emergency Medicine, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
10Department of Emergency Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
11Department of Emergency Medicine, Faculty of Medicine, Acibadem University, Ankara, Turkey
12Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
Keywords: Emergency medicine, oligoanalgesia, pain, pain management, Turkey
OBJECTIVES: This study aimed to evaluate pain management practices in the emergency departments (EDs) in Turkey and to evaluate the prevalence and etiologies of oligoanalgesia to identify possible improvement strategies.
METHODS: This multicenter cross-sectional observational study was conducted in 10 tertiary care hospitals in Turkey. Patients who were admitted to the ED with pain chief complaints were included in the study. Both patients and physicians were surveyed with two separate forms by the research associates, respectively. The patient survey collected data about the pain and the interventions from the patients' perspective. The pain was evaluated using the Numerical Rating Scale. The physician survey collected data to assess the differences between study centers on pain management strategies and physician attitudes in pain management.
RESULTS: Ten emergency physicians and 740 patients (male/female: 365/375) enrolled in the study. The median pain score at admission at both triage and ED was 7 (interquartile range: 5–8). The most frequent type of pain at admission was headache (n = 184, 24.7%). The most common analgesics ordered by physicians were nonsteroidal anti-inflammatory drugs (n = 505, 67.9%), and the most frequent route of administration was intramuscular injection (n = 396, 53.2%). About half of the patients (n = 366, 49.2%) received analgesics 10–30 min from ED admission. The posttreatment median pain score decreased to 3 (P < 0.001). About 79.2% of patients did not need a second analgesic administration (n = 589), and opioid analgesics were the most frequently administered analgesic if the second application was required. Physicians prescribed an analgesic at discharge from the ED in 55.6% of the patients (n = 414) and acute pain was present in 7.5% (n = 56) of the patients.
CONCLUSION: Our study on the pain management practices in the EDs in Turkey suggested that high rate of intramuscular analgesic use and long emergency room stay durations are issues that should constitute the focus of our quality improvement efforts in pain management.
Kocaeli University, Clinical Research Ethical Committee, Date: 17.09.2019, Approval number: 2019/226.
MC, BK, OC, and SY conceived the study, designed the trial, and was also responsible for the study's scientific validity. BK, TYK, NDH, SG, SEE, SNA, OGC, DP, and EU undertook recruitment of participating centers and patients. MC, OC, and SY provided statistical advice on study design and analyzed the data; SY and OC chaired the data oversight committee. MC drafted the manuscript, and all the authors contributed substantially to its revision. MC takes responsibility for the study as a whole.
Emergency Medicine Association of Turkey, where all authors are members to, holds the responsibility of this research which is funded by Abdi İbrahim Pharmaceuticals in which authors have no business or financial interests.