School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia.
Emerg Med Australas. 2019 Dec;31(6):989-996. doi: 10.1111/1742-6723.13294. Epub 2019 Apr 5.
To quantify the impact of cognitive impairment on pain assessment and management practices in the ED.
A retrospective, cross-sectional study of patient records was conducted for all elderly patients (65 years or older) who presented to the ED of a large Western Australian tertiary hospital with a fracture because of a fall between 6 February and 14 December 2015. Of 327 records identified, 318 were suitable for data extraction. Of these, 120 patients had a cognitive impairment. Primary outcome measures were the method and frequency of pain assessment, and the delay to the administration of a pain intervention after pain was first assessed for patients with and without a cognitive impairment.
Patients with a cognitive impairment were less likely to have their pain assessed with a standardised pain assessment tool (55% vs 91.4%, P < 0.001), and 9.4 times more likely to have their pain assessed using ad hoc assessments only (95% confidence interval 4.6-19.1). The median time between ED presentation and a patient's first pain assessment was longer for patients with cognitive impairment (28 vs 17 min; P < 0.001), as was the time between repeat assessments (81 vs 62 min; P < 0.004). The median times to receive a pain intervention following pain assessment were 51 and 50 min for cognitively intact and impaired patients, respectively (P = 0.209, after adjustment for the first pain score).
Pain is inadequately and inappropriately assessed for elderly patients with a cognitive impairment in the ED, resulting in delays in initiation of pain management.
量化认知障碍对急诊科疼痛评估和管理实践的影响。
对 2015 年 2 月 6 日至 12 月 14 日期间因跌倒导致骨折而在西澳大利亚州一家大型三级医院急诊科就诊的所有老年患者（65 岁或以上）进行了一项回顾性、横断面研究。在确定的 327 份记录中，有 318 份适合提取数据。其中，120 名患者存在认知障碍。主要观察指标为疼痛评估的方法和频率，以及在首次评估疼痛后给予疼痛干预的时间延迟，分别为有和无认知障碍的患者。
认知障碍患者使用标准化疼痛评估工具评估疼痛的可能性较小（55%比 91.4%，P<0.001），而仅使用临时评估的可能性要高 9.4 倍（95%置信区间 4.6-19.1）。认知障碍患者从急诊科就诊到首次疼痛评估的中位数时间较长（28 分钟比 17 分钟；P<0.001），重复评估的中位数时间也较长（81 分钟比 62 分钟；P<0.004）。在接受疼痛评估后接受疼痛干预的中位数时间分别为认知正常和认知障碍患者的 51 分钟和 50 分钟（在调整首次疼痛评分后，P=0.209）。
在急诊科，认知障碍的老年患者的疼痛评估不足且不恰当，导致疼痛管理的启动延迟。
