ANALGESIC PRACTICE FOR ACUTE ORTHOPEDIC TRAUMA PAIN IN COSTA-RICAN EMERGENCY DEPARTMENTS

Study objective: Studies in US emergency departments have demonstrated that pain is undertreated in adults and children. Previous studies ha ve also demonstrated cultural differences in the expression and percep tion of pain. The objective of this investigation was to describe the analgesic practices and patient pain responses in two Costa Rican EDs in light of possible differences due to cultural variation. Methods: W e carried out a prospective, noninterventional observational assessmen t protocol of a convenience sample of patients being treated for ortho pedic trauma in two university-affiliated urban teaching hospital EDs. Children between the ages of 5 and 12 years and ail adults, ages 16 t o 63, who presented with painful orthopedic trauma were included. Pati ents quantified their pain on arriving at and before leaving the ED. C hildren used a Face Interval Scale ranging from 1 (no pain) to 9 (maxi mum pain), and adults used a numeric rating scale ranging from 0 to 10 . Results: One fourth of pediatric and more than half of all adult pat ients had no reduction in their pain scores on leaving the ED. Eleven percent of adults and fewer than 4% of children received pain treatmen t while in the ED. Fewer than half of all patients were sent home with analgesics. We observed no use of opioids in the ED for analgesia. Co nclusion: Our data illustrate that both adults and children with sever e pain resulting from orthopedic injury in the Costa Rican EDs we stud ied often receive inadequate or no analgesic treatment. This finding s uggests that the phenomenon of oligoanalgesia is more widespread and r esistant to cultural differences. We also noted a reluctance to use op ioids in this setting.