Evaluation of EM and orthopedic residents' pain estimation about patients with limb trauma who were visited in the Emergency Department of Hazrat Rasoul Hospital

Objective

To evaluate pain estimation in the patients with limb(s) trauma by EM and orthopedic resident in the Emergency Department (ED) of Hazrat-e-Rasoul Hospital.

Patients and methods

In a prospective study, 160 patients that merely had limb(s) trauma and were admitted to the EM ward of Hazrat Rasoul Hospital were included. Patients with GSC <15 – due to every reason, like head trauma, drug overdose, and so on – at the time of physical examination, and positive history of analgesic use before ED arrival or history of drug or alcohol abuse, were excluded from this study. At the time of the presentation to the ED, first of all the patients marked the level of their pain on a visual analogue scale (VAS) scale by supervision of the researchers and then the EM and orthopedic residents marked the pain level of every patient on a VAS, separately. The EM and orthopedic residents select randomly from on-call residents.

Results

Of 160 enrolled cases (65 females and 95 males), the mean age was 32.05 ± 17.87 years. The mean of pain scores determined by the patients was 6.41 ± 2.52. The mean of the recorded pain scores by EM and orthopedic residents was 4.41 ± 1.83 and 4.05 ± 1.92, respectively. There was a significant difference between the mean of patients' scores and the mean of pain scores determined by both the EM and orthopedic residents, separately (P < 0.001); but there is no significant difference between EM and orthopedic residents. Pain estimation of EM and orthopedic residents in 20 cases were the same as the patient pain score.

Conclusion

According to previous studies, the only accurate barometer in treating pain is the patient's report, but in our center pain treatment was done according to physicians' estimation; our study indicates that they underestimate the pain of their patients. To properly sedate patients, the VAS should be included as a routine part of vital signs and the pain score should be recorded, especially for such patients who have pain and might need painful procedures.