Severe acute pain in emergency medicine. The keys for analgesia efficiency.

Objective:To measure severe acute pain (SAP) frequency, to describe SAP man agement and to bring to view the conditions of analgesia success in emergen cy medicine. Design: Multicentre prospective survey: 7 days in Emergency Departments (ED ), 30 days in Mobile Intensive Care Units (MICU). Multivariate analysis to measure the independent effect on pain relief of factors identified by Chi squared test. Setting: All of 6 ED and 8 MICU of a French region. Patients: Over 15 years of age. Main outcome measures: Pain intensity was assessed with Visual Analog Scale (VAS) before and after ED or MICU management. SAP group (defined by initia l VAS score > 40 mm) was analyzed for pain relief (defined by final VAS sco re less than or equal to 40 mm). Influence on pain relief through pain aeti ology, initial pain intensity, treatment delay and opioid use was analyzed. Results: 1,082 fulfilled medical forms for 3,419 eligible patients. SAP fre quency was estimated 36% (Cl-95 = 34-38%) in ED and 29% (Cl-95 = 25-33%) in MICU. SAP (n = 368) was often persistent: 45% (Cl-95 = 43-47%) after disch arge from ED and 26% (Cl-95 = 22-30%) after MICU intervention. The prognost ic factors of pain control success revealed by Chi squared test were: MICU (vs ED), treatment delay less than or equal to 3 hours (vs > 3 hours), opio id use (vs non opioid use) and VAS pain level less than or equal to 70 mm ( vs > 70 mm). The last 3 factors were confirmed by multivariate analysis. Tr eatment delay, opioid use, and pain level were found to be determinants of efficient analgesia for SAP. Conclusion: Despite the high frequency of SAP in ED and MICU, pain control is not satisfying. Opioid use and early treatment are determinant in analge sia efficiency for SAP and should be therefore encouraged to improve pain r elief in emergency medicine. (C) 2001 Editions scientifiques et medicales E lsevier SAS.