Pain assessment and management of trauma patients in an emergency department of a tertiary hospital in Tanzania

Abstract

Proper pain assessment is a core component in management of trauma patients but prior literature has suggested that pain management is inadequate in emergency settings. With the development of emergency medicine in low-income countries (LIC), the procedures for pain assessment and management of trauma patients have not been well studied and protocols have not been established. We aimed to describe practices of pain assessment and management in an emergency department in Tanzania. This was a prospective cohort study of consecutive adult trauma patients presenting to the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH) in Dar es Salaam, Tanzania, from July 2017 to December 2017. A case report form (CRF) was used to record demographics and clinical characteristics of participants, whether or not pain was assessed at either triage or in the treatment area, and the administration of pain medications. The assistant also assessed pain independently with the numeric rating scale (NRS) of (0–10). Outcomes were proportions of patients who received pain assessment, patients who received pain medication, and types of medications administered. Descriptive data is summarised using frequency, percentage, and median with interquartile ranges as appropriate. Chi-square tests were used to determine association between pain assessments, receipt of pain medication, and types of medications. We enrolled 311 (10.9%) trauma patients during the period of study. The median age was 32 years (IQR 25–43 years), and 228 (73.3%) were male. The most common mechanism of injury was motor vehicle crash 185 (59.4%), and of these, 87 (47%) involved motorcycles. Three hundred ten (99.6%) patients had pain assessment documented arrival, and 285 (91.6%) had a second assessment. Pain scores obtained by the research assistant were as follows: mild pain score (NRS 1–3) 154 (49.5%) patients, moderate pain (NRS 4–6) 68 (21.8%), and severe pain (NRS 7–10) 89 (28.7%). Pain medications were given to 144 (46.3%) patients, 29 (20.1%) of those with mild pain, 41 (28.7%) of those with moderate pain score, and 74 (51.4%) of those with severe pain. The use of opiates increased with increased pain severity. In this ED in LIC, the assessment of pain was well documented; however, less than half of patients with documented pain received pain medication while at the ED. Future studies should focus on identification of factors affecting the provision of pain medications to trauma patients in the ED.