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A simplified way for the urgent treatment of somatic pain in patients admitted to the emergency room: the SUPER algorithm

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Abstract

Somatic pain is one of the most frequent symptoms reported by patients presenting to the emergency department (ED), but, in spite of this, it is very often underestimated and under-treated. Moreover, pain-killers prescriptions are usually related to the medical examination, leading to a delay in its administration, thus worsening the patient’s quality of life. With our study, we want to define and validate a systematic and homogeneous approach to analgesic drugs administration, testing a new therapeutic algorithm in terms of earliness, safety, and efficacy. 442 consecutive patients who accessed our ED for any kind of somatic pain were enrolled, and then randomly divided into two groups: group A follow the normal process of access to pain-control drugs, and group B follow our SUPER algorithm for early administration of drugs to relieve pain directly from triage. We excluded from the study, patients with abdominal pain referred to the surgeon, patients with headache, recent history of trauma, history of drug allergies, and life-threatening conditions or lack of cooperation. Drugs used in the study were those available in our ED, such as paracetamol, paracetamol/codeine, ketorolac-tromethamine, and tramadol-hydrochloride. Pain level, risk factors, indication, and contraindication of each drug were taken into account in our SUPER algorithm for a rapid and safe administration of it. The Verbal Numeric Scale (VNS) and the Visual Analog Scale (VAS) were used to verify the patient’s health and perception of it. Only 59 patient from group A (27.1 %) received analgesic therapy (at the time of the medical examination) compared to 181 patients (100 %) of group B (p < 0.001). Group B patients, received analgesic therapy 76 min before group A subjects (p < 0.01), resulting in a significant lower VNS (7.31 ± 1.68 vs 4.75 ± 2.3; p < 0.001), and a superior VAS after discharge (54.43 ± 22.16 vs 61.30 ± 19.13; p < 0.001) compared to group A subjects. No significant differences concerning side effects were observed between group A and group B patients. Early administration of a pain-control therapy directly from triage is safe and effective, and significantly improves patients perceptions of their own health.

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Acknowledgments

We thank the Orthopedic team of our ED, Proietti Luca, Pola Enrico, Zirio Gianfranco, Genitiempo Maurizio, Marrocco Raffaella, Conti Carla, Rocchi Lorenzo, and Merendi Gianfranco for the time spent in patient’ enrollment.

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Authors and Affiliations

  1. Emergency Department, Catholic University of Sacred Heart, Policlinico “A. Gemelli”, Largo A. Gemelli, 8, 00168, Rome, Italy

    Francesco Franceschi, Davide Marsiliani, Andrea Alesi, Maria Grazia Mancini, Veronica Ojetti, Marcello Candelli, Maurizio Gabrielli, Gabriella D’Aurizio, Emanuele Gilardi, Enrica Adducci, Rodolfo Proietti & Francesco Buccelletti

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  1. Francesco Franceschi
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  2. Davide Marsiliani
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  3. Andrea Alesi
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  4. Maria Grazia Mancini
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  6. Marcello Candelli
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Correspondence to Francesco Franceschi.

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Statement of human and animal rights

All procedures performed in this study involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all subjects included in the study.

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Franceschi, F., Marsiliani, D., Alesi, A. et al. A simplified way for the urgent treatment of somatic pain in patients admitted to the emergency room: the SUPER algorithm. Intern Emerg Med 10, 985–992 (2015). https://doi.org/10.1007/s11739-015-1304-7

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  • DOI: https://doi.org/10.1007/s11739-015-1304-7

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