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Impact of pain location, organ system and treating speciality on timely delivery of analgesia in emergency departments


  • Kim Hansen, MBBS(HonsI) FACEM, Emergency Physician; Ogilvie Thom, MBBS FACEM, Director of Emergency Medicine Research, Emergency Physician; Hamish Rodda, MBBS, Emergency Registrar; Melanie Price, BN, Graduate Diploma (Emergency Nursing), Nurse Practitioner Candidate; Chris Jackson, BN, Graduate Diploma of Nursing Practice (Critical Care), Registered Nurse; Scott Bennetts, B.Health Sc. (Nursing), Graduate Diploma Critical Care Nursing, Graduate Certificate Health Promotion, Assistant Director; Steven Doherty, PhD MBBS FACEM, Director, University of Newcastle, Emergency Physician Tamworth Base Hospital; Harry Bartlett PhD BSc(HonsI) BEng(Hons), Associate Lecturer.

Dr Kim Hansen, Emergency Department, The Prince Charles Hospital, 627 Rode Road, Chermside, Qld 4032, Australia. Email:


Objective: This retrospective, observational cohort study investigated whether the clinical features of a patient's pain, including anatomical location, organ system and likely treating speciality, impact on the delivery of analgesia within 30 min in EDs.

Methods: Data were obtained from 24 centres across Australia between April 2008 and March 2009. Principal outcome was delivery of analgesia within 30 min or less. Factors that might explain any differences were analysed, including anatomical location of the pain, likely treating speciality, organ system affected, age, sex, day and time of presentation, hospital location, documented pain score and triage category. Analysis was by the χ2-test for independence of proportions and multiple logistic regression. A P-value <0.05 was considered statistically significant.

Results: There were 4598 patients, of whom 2578 were male. The median age was 36 years (range 0–103). Both limb origin of pain (χ2= 46.1, P < 0.001) and documentation of a pain score (χ2= 48.6, P < 0.001) were strongly associated with delivery of analgesia within 30 min. Attending a rural ED was a significant risk factor for delayed analgesia (χ2= 12.5, P < 0.001). Burns patients (40.2%, 47 of 117, P < 0.001) and orthopaedic patients (26.1%, 259 of 992, P < 0.001) were much more likely to received analgesia within 30 min than the mean (19.5%, 896 of 4598).

Conclusions: Patients presenting with burns, orthopaedic conditions or with a limb location of pain are more likely to receive analgesia within 30 min in Australian EDs. Clinicians should be aware of possible trends in the delivery of timely analgesia to patients with pain.