Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures

Study objective: To compare patient and practitioner assessments of pain as sociated with commonly performed emergency department procedures and use of anesthetics before these procedures. Methods: This was a prospective, observational, cross-sectional study condu cted at a university-based ED with a convenience sample of ED patients. Res earch assistants recorded the procedure performed and historical and demogr aphic information on standardized data collection instruments. After each p rocedure, both the patient and practitioner independently recorded assessme nts of patient pain on a 100-mm visual:analog scale (VAS). Use of preproced ure anesthetics and patient preferences regarding their use were also ident ified. Categorical variables were analyzed by chi(2) tests. Patient and pra ctitioner VAS scores were compared using a paired t test; a was preset at . 05. Correlation coefficients were calculated to assess correlation between patient and practitioner pain scores. Results: A total of 1,171 procedures were evaluated for the 15 most common procedures performed. The mean patient age was 42.8+/-18.7 years and 46.1% were male. Overall, the mean patient VAS was 20.8 mm+/-25.1 mm; the mean pr actitioner VAS was 23.5 mm+/-20.3 mm. The mean difference between groups wa s 3.0 mm (95% confidence interval [Cl],1.3 to 4.2). Correlation between pat ient and practitioner pain scores for individual procedures was poor to fai r (r=.26 to .68.) The most painful procedures according to patients in desc ending order were nasogastric intubation, abscess drainage, fracture reduct ion, and urethral catheterization. Local anesthetics were administered in 1 2.8% of procedures yet would be requested before similar future procedures by 17.1% of patients. Patients who would choose local anesthetics in the fu ture gave higher pain scores than those who would not (43.3 mm versus 16.3 mm; mean difference=27.0 mm, 95% CI, 22.2 to 31.8 mm). Conclusion: The most painful procedures for ED patients were nasogastric in tubation, incision and drainage of abscesses, fracture reduction, and ureth ral catheterization. Although practitioners also identified these procedure s as most painful, the correlation between patient and practitioner pain as sessments in individual patients was highly variable. Overall use of anesth etics before these procedures was low. Practitioners should be attentive to their patients' individual anesthetic needs before performing painful proc edures.