Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures

Study objective: To compare patient and practitioner assessments of pain associated with commonly performed emergency department procedures and use of anesthetics before these procedures. Methods: This was a prospective, observational, cross-sectional study conducted at a university-based ED with a convenience sample of ED patients. Research assistants recorded the procedure performed and historical and demographic information on standardized data collection instruments. After each procedure, both the patient and practitioner independently recorded assessments of patient pain on a 100-mm visual analog scale (VAS). Use of preprocedure anesthetics and patient preferences regarding their use were also identified. Categorical variables were analyzed by varkappa2 tests. Patient and practitioner VAS scores were compared using a paired t test; α was preset at .05. Correlation coefficients were calculated to assess correlation between patient and practitioner pain scores. Results: A total of 1, 171 procedures were evaluated for the 15 most common procedures performed. The mean patient age was 42.8±18.7 years and 46.1% were male. Overall, the mean patient VAS was 20.8 mm±25.1 mm; the mean practitioner VAS was 23.5 mm±20.3 mm. The mean difference between groups was 3.0 mm (95% confidence interval [Cl], 1.3 to 4.1). Correlation between patient and practitioner pain scores for individual procedures was poor to fair (r=26 to .68). The most painful procedures according to patients in descending order were nasogastric intubation, abscess drainage, fracture reduction, and urethral catheterization. Local anesthetics were administered in 12.8% of procedures yet would be requested before similar future procedures by 17.1% of patients. Patients who would choose local anesthetics in the future gave higher pain scores than those who would not (43.3 mm versus 16.3 mm; mean difference=27.0 mm, 95% Cl, 22.2 to 31.8 mm). Conclusion: The most painful procedures for ED patients were nasogastric intubation, incision and drainage of abscesses, fracture reduction, and urethral catheterization. Although practitioners also identified these procedures as most painful, the correlation between patient and practitioner pain assessments in individual patients was highly variable. Overall use of anesthetics before these procedures was low. Practitioners should be attentive to their patientsʹ individual anesthetic needs before performing painful procedures.