Renal colic patient pain management in the emergency department

Abstract

Study objectives: Patients with renal colic experience significant pain on emergency department (ED) presentation. This study analyzes the factors that predict ED pain management. Methods: Patient selection was based on the ED logbook diagnoses of renal, ureteral, or unspecified urinary calculi or hydronephrosis. Medical records of patients treated in the ED from June 20, 2001, through June 11, 2002, in 5 urban EDs were retrospectively reviewed. Patients younger than 18 years were excluded. When a numeric pain scale was used, 8 to 10 was considered severe, 4 to 7 moderate, and 1 to 3 mild pain severity. Results: Of the 227 patients with renal colic who presented to the ED, 63% were men, and the mean age was 44±15 years. Patients reported severe (74%), moderate (12%), and mild (3%) maximal pain severities while in the ED. In the patients (86%) who received a pain medication, 68% received a nonsteroidal anti-inflammatory drug (NSAID), 54% a narcotic, and 37% a narcotic and an NSAID. A parenteral medication was given to 83% of patients while in the ED. Patients most commonly were administered ketorolac (40%), morphine (26%), promethazine (23%), hydromorphone (15%), and meperidine (8%). Patients in moderate to severe pain were 41% more likely to receive a pain medication (89% versus 63%, adjusted odds ratio [OR] 4.7, P=.01), 2.7 times more likely to receive a narcotic (59% versus 22%, adjusted OR=5.0, P=.01), and 37% more likely to receive a parenteral medication (86% versus 63%, adjusted OR=3.5, P=.01), but patients 65 years or older were less likely to receive a pain medication (67% versus 87%, adjusted OR=0.3, P=.03). Of the 174 (77%) patients discharged home from the ED, 73% received a narcotic prescription. Conclusion: Patients presenting to the ED with renal colic are most often in severe pain and receive a parenteral NSAID. Pain severity was positively correlated with pain medication administration and the use of narcotics and parenteral medications. Elderly patients are at risk for inadequate analgesia. Study objectives: Patients with renal colic experience significant pain on emergency department (ED) presentation. This study analyzes the factors that predict ED pain management. Methods: Patient selection was based on the ED logbook diagnoses of renal, ureteral, or unspecified urinary calculi or hydronephrosis. Medical records of patients treated in the ED from June 20, 2001, through June 11, 2002, in 5 urban EDs were retrospectively reviewed. Patients younger than 18 years were excluded. When a numeric pain scale was used, 8 to 10 was considered severe, 4 to 7 moderate, and 1 to 3 mild pain severity. Results: Of the 227 patients with renal colic who presented to the ED, 63% were men, and the mean age was 44±15 years. Patients reported severe (74%), moderate (12%), and mild (3%) maximal pain severities while in the ED. In the patients (86%) who received a pain medication, 68% received a nonsteroidal anti-inflammatory drug (NSAID), 54% a narcotic, and 37% a narcotic and an NSAID. A parenteral medication was given to 83% of patients while in the ED. Patients most commonly were administered ketorolac (40%), morphine (26%), promethazine (23%), hydromorphone (15%), and meperidine (8%). Patients in moderate to severe pain were 41% more likely to receive a pain medication (89% versus 63%, adjusted odds ratio [OR] 4.7, P=.01), 2.7 times more likely to receive a narcotic (59% versus 22%, adjusted OR=5.0, P=.01), and 37% more likely to receive a parenteral medication (86% versus 63%, adjusted OR=3.5, P=.01), but patients 65 years or older were less likely to receive a pain medication (67% versus 87%, adjusted OR=0.3, P=.03). Of the 174 (77%) patients discharged home from the ED, 73% received a narcotic prescription. Conclusion: Patients presenting to the ED with renal colic are most often in severe pain and receive a parenteral NSAID. Pain severity was positively correlated with pain medication administration and the use of narcotics and parenteral medications. Elderly patients are at risk for inadequate analgesia.