Intervention Study with Algoplus : A Pain Behavioral Scale for Older Patients in the Emergency Department.

OBJECTIVES

Evaluation of acute pain is often difficult in older patients admitted to the Emergency Department (ED), and self-evaluation of pain is not always possible. This observational study evaluates how the systematic use of Algoplus , a validated behavioral scale, could improve pain management of older persons admitted to the ED.

METHOD

The intervention study (NCT 02258503) took place in 4 steps in the ED, University Hospital Clermont-Ferrand, France. Pain assessment and analgesics prescription were collected from medical files for 3 months. For 6 months, the whole staff of the ED were trained on pain assessment and to use Algoplus scale (3-same as step 1). To evaluate the intervention, pain assessment and analgesics prescription were compared before and after implementation by 2-sided tests with a type I error set at α = 0.05.

RESULTS

The intervention led to systematic pain evaluation with Algoplus in 100% of patients (≥ 75 years old, n = 434) and was completed by numeric rating scale (NRS) and other evaluations. Pearson's correlation between NRS ≥ 3 and Algoplus < 2 was 0.61. Prescription of analgesics (+6%) especially opioids increased nonsignificantly but was similar for all patients whatever the evaluation.

CONCLUSIONS

The systematic introduction of Algoplus scale in the ED allowed a change in practice by improving evaluation and management of pain in patients ≥ 75 years old, especially when difficult to be evaluated. Algoplus allowed an objective levelling of analgesics prescription in all admitted patients. It also promoted field action to improve pain management in ED.