Douleur aiguë intense en médecine d’urgence. Les clefs d’une analgésie efficace

Abstract

Objective: To measure severe acute pain (SAP) frequency, to describe SAP management and to bring to view the conditions of analgesia success in emergency 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 initial VAS score > 40 mm) was analyzed for pain relief (defined by final VAS score ≤ 40 mm). Influence on pain relief through pain aetiology, initial pain intensity, treatment delay and opioid use was analyzed. Results: 1,082 fulfilled medical forms for 3,419 eligible patients. SAP frequency was estimated 36% (CI 95 = 34-38%) in ED and 29% (CI 95 = 25-33%) in MICU. SAP ( n = 368) was often persistent : 45% (CI 95 = 43-47%) after discharge from ED and 26% (CI 95 = 22-30%) after MICU intervention. The prognostic factors of pain control success revealed by Chi squared test were: MICU (vs ED), treatment delay ≤ 3 hours (vs > 3 hours), opioid use (vs non opioid use) and VAS pain level ≤ 70 mm (vs > 70 mm). The last 3 factors were confirmed by multivariate analysis. Treatment 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 analgesia efficiency for SAP and should be therefore encouraged to improve pain relief in emergency medicine.