Pain induced by investigations and procedures commonly administered to older adults in the emergency department: a prospective cohort study

Abstract

BackgroundThis study aimed to assess the level of pain induced by common interventions performed in older adults consulting to the ED.MethodsWe conducted a prospective multicentre observational cohort study in two academic EDs (Quebec City, Canada) between June 2018 and December 2019. A convenience sample of well-oriented and haemodynamically stable older adults (≥65 years old) who underwent at least two interventions during their ED stay was recruited. The level of pain was assessed using an 11-point Numerous Rating Scale (NRS) and is presented using median and IQR or categorised as no pain (0), mild (1–3), moderate (4–6) or severe pain (7–10).ResultsA total of 318 patients were included. The mean age was 77.8±8.0 years old and 54.4% were female . The number of pain assessments per intervention ranged between 22 (urinary catheterisation) and 240 (intravenous catheter). All imaging investigations (X-rays, CT and bedside ultrasound) were associated with a median level of pain of 0. The median level of pain for other interventions was as follows: blood samplings (n=231, NRS 1 (IQR 0–3)), intravenous catheters (n=240, NRS 2 (IQR 0–4)), urinary catheterisations (n=22, NRS 4.5 (IQR 2–6)), cervical collars (n=50, NRS 5 (IQR 0–8)) and immobilisation mattresses (n=34, NRS 5 (IQR 0–8)). Urinary catheterisations (63.8%), cervical collars (56.0%) and immobilisation mattresses (52.9%) frequently induced moderate or severe pain.ConclusionsMost interventions administered to older adults in the ED are associated with no or low pain intensity. However, urinary catheterisation and spinal motion restriction devices are frequently associated with moderate or severe pain.