RESUMEN
STUDY OBJECTIVE: Studies in US emergency departments have demonstrated that pain is undertreated in adults and children. Previous studies have also demonstrated cultural differences in the expression and perception of pain. The objective of this investigation was to describe the analgesic practices and patient pain responses in two Costa Rican EDs in light of possible differences due to cultural variation. METHODS: We carried out a prospective, noninterventional observational assessment protocol of a convenience sample of patients being treated for orthopedic trauma in two university-affiliated urban teaching hospital EDs. Children between the ages of 5 and 12 years and all adults, ages 16 to 63, who presented with painful orthopedic trauma were included. Patients quantified their pain on arriving at and before leaving the ED. Children used a Face Interval Scale ranging from 1 (no pain) to 9 (maximum pain), and adults used a numeric rating scale ranging from 0 to 10. RESULTS: One fourth of pediatric and more than half of all adult patients had no reduction in their pain scores on leaving the ED. Eleven percent of adults and fewer than 4% of children received pain treatment while in the ED. Fewer than half of all patients were sent home with analgesics. We observed no use of opioids in the ED for analgesia. CONCLUSION: Our data illustrate that both adults and children with severe pain resulting from orthopedic injury in the Costa Rican EDs we studied often receive inadequate or no analgesic treatment. This finding suggests that the phenomenon of oligoanalgesia is more widespread and resistant to cultural differences. We also noted a reluctance to use opioids in this setting.
Asunto(s)
Analgesia/métodos , Servicio de Urgencia en Hospital , Ortopedia , Manejo del Dolor , Heridas y Lesiones/terapia , Enfermedad Aguda , Adolescente , Adulto , Analgesia/estadística & datos numéricos , Niño , Preescolar , Costa Rica , Características Culturales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ortopedia/estadística & datos numéricos , Dolor/etiología , Dimensión del Dolor/estadística & datos numéricos , Estudios Prospectivos , Heridas y Lesiones/complicacionesRESUMEN
The authors hypothesized that data analysis in the current emergency medicine literature uses relatively few methods and sought to determine the frequency distributions of each method of analysis. The authors defined their population as original contributions in three refereed emergency medicine journals from September, 1985 through July, 1989. Letters to the editor, brief reports, reviews, and case reports were excluded. The authors reviewed 250 randomly selected articles and identified the method(s) of data analysis in each. The absolute frequency distribution of statistics were as follows: descriptive statistics only, 31%; contingency tables, 35% (chi 2, 28.4%; Fisher's exact test, 13.2%; McNemar's test, 0.4%); Student's t-test, 34%; ANOVA/ANCOVA, 12%; regression techniques, 8% (simple linear regression, 4.0%; multiple regression, 3.6%; logistic regression, 1.6%); nonparametric tests, 7% (Mann-Whitney, 2.8%; Wilcoxon, 2.4%; Dunnett, 0.8%; Kolmogorv-Smirnov, 0.4%; Kruskal-Wallis, 0.4%); multiple comparisons, 6% (Scheffé, 4.4%; Newman-Keuls, 2.0%); correlation techniques, 4% (Pearson product-moment correlation coefficient, 2.8%; Kendall's tau, 0.8%; Spearman's rho, 0.4%); confidence intervals, 2%. Correction techniques were used in 9% (Dunn-Bonnferoni, 4.8%; Yates correction, 4.4%). No statistics were found in 2% of the articles reviewed. Five statistical methods account for the vast majority (97% cumulative) of statistical uses in emergency medicine literature. This information should prove useful in deciding which tests should be emphasized in educating emergency physicians.