Patient and physician agreement on abdominal pain severity and need for opioid analgesia

Whereas controversy surrounds emergency department (ED) analgesia administr ation to patients with undifferentiated abdominal pain, few studies have ad dressed the level of patient-physician agreement on abdominal pain severity and need for opioid analgesia. This prospective study was undertaken to as sess concordance between emergency physicians and patients on abdominal pai n severity. Study subjects were a convenience sample of 30 adults seen in a n urban university-affiliated tertiary care ED (annual census 65,000) who h ad undifferentiated abdominal pain meeting an initial severity threshold of 5 on a 10cm visual analog scale (VAS) marked by the patient, Patients' and physicians' VAS scores, obtained in blinded fashion at presentation (t0) a nd at one (t1) and two (t2) hours into the ED stay, were compared with t te st (VAS scores) and sign-rank (percent change in VAS scores) analyses, In a ddition, patients and physicians were asked at each assessment time, in bli nded fashion, "Is the pain severe enough to warrant morphine?" The kappa st atistic was used to characterize the degree of agreement between physician and patient assessments as to whether opioids were indicated. At t0, t1, an d t2, patients' mean VAS scores (7.5, 6.7, and 5.1) were significantly (P < .05) higher than the corresponding physicians' VAS scores (5.3, 4.7, and 3 .9). Though VAS scores for physicians started lower than those of patients, the percentage changes in scores from one assessment to the next were simi lar by Wilcoxon sign-rank testing (P > .50 for time intervals t0 - t1 and t 1 - t2). Overall, patients and physicians agreed on the question of whether pain was sufficient to warrant opioids in 71 of 90 (78.9%) assessments; th e corresponding kappa statistic of .57 indicated moderate agreement (P < .0 001), These results, indicating that patients and physicians usually agree on whether opioids are warranted for abdominal pain, have important implica tions for further research an ED analgesia in this population. Copyright (C ) 1999 by W.B Saunders Company.