Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

Fry, M; Chenoweth, L; Arendts, G

Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

Fry, M

Chenoweth, L Arendts, G

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Publication Type:: Journal Article
Citation:: Emergency Medicine Journal, 2018, 35 (1), pp. 33 - 38
Issue Date:: 2018-01-01

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Field	Value	Language
dc.contributor.author	Fry, M https://orcid.org/0000-0003-1265-7096	en_US
dc.contributor.author	Chenoweth, L	en_US
dc.contributor.author	Arendts, G	en_US
dc.date.available	2017-07-16	en_US
dc.date.issued	2018-01-01	en_US
dc.identifier.citation	Emergency Medicine Journal, 2018, 35 (1), pp. 33 - 38	en_US
dc.identifier.issn	1472-0205	en_US
dc.identifier.uri	http://hdl.handle.net/10453/123394
dc.description.abstract	© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. Objective The primary objective of the study was to measure the impact of an observational pain assessment dementia tool on time from ED arrival to first dose of analgesic medicine. Methods A multisite cluster randomised controlled trial was conducted to test the Pain Assessment in Advanced Dementia (PAINAD) tool. Patients aged 65 years or older suspected of a long bone fracture were screened for cognitive impairment using the Six-Item Screening (SIS) tool. Patients scoring 4 or less on SIS (intervention sites) were assessed for pain using PAINAD. Control sites, assessed pain using standard methods. The primary outcome was time to first dose of analgesia and was analysed on an intention-to-treat basis with a sensitivity analysis. Results We enrolled 602 patients, of which 323 (54%) were at intervention sites (n=4). The median time to analgesia was 82 min (IQR 45-151 min). There was no statistically significant difference in median time to analgesia for intervention 83 (IQR 48-158 min) and nonintervention 82 min (IQR 41-147 min) sites (p=0.414). After adjusting for age, fracture type, arrival mode and triage category, there remained no significant difference in time to analgesia (HR 0.97, 95% CI 0.80 to 1.17, p=0.74). Of the 602 patients enrolled, 273 actually had cognitive impairment. A sensitivity analysis demonstrated patients at intervention sites received analgesia 13 min sooner (90 vs 103 min, p=0.91). Conclusion Use of the PAINAD was not associated with a shorter time to analgesia, although there was a clinically important but non-significant improvement in the cognitively impaired patient group. Further research is needed to address this clinically important and complex issue.	en_US
dc.relation.ispartof	Emergency Medicine Journal	en_US
dc.relation.isbasedon	10.1136/emermed-2016-206065	en_US
dc.subject.classification	Emergency & Critical Care Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Pain	en_US
dc.subject.mesh	Analgesics	en_US
dc.subject.mesh	Pain Measurement	en_US
dc.subject.mesh	Analgesia	en_US
dc.subject.mesh	Cluster Analysis	en_US
dc.subject.mesh	Cognition	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Pain Management	en_US
dc.title	Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	35	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Nursing
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	35	en_US

Abstract:

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. Objective The primary objective of the study was to measure the impact of an observational pain assessment dementia tool on time from ED arrival to first dose of analgesic medicine. Methods A multisite cluster randomised controlled trial was conducted to test the Pain Assessment in Advanced Dementia (PAINAD) tool. Patients aged 65 years or older suspected of a long bone fracture were screened for cognitive impairment using the Six-Item Screening (SIS) tool. Patients scoring 4 or less on SIS (intervention sites) were assessed for pain using PAINAD. Control sites, assessed pain using standard methods. The primary outcome was time to first dose of analgesia and was analysed on an intention-to-treat basis with a sensitivity analysis. Results We enrolled 602 patients, of which 323 (54%) were at intervention sites (n=4). The median time to analgesia was 82 min (IQR 45-151 min). There was no statistically significant difference in median time to analgesia for intervention 83 (IQR 48-158 min) and nonintervention 82 min (IQR 41-147 min) sites (p=0.414). After adjusting for age, fracture type, arrival mode and triage category, there remained no significant difference in time to analgesia (HR 0.97, 95% CI 0.80 to 1.17, p=0.74). Of the 602 patients enrolled, 273 actually had cognitive impairment. A sensitivity analysis demonstrated patients at intervention sites received analgesia 13 min sooner (90 vs 103 min, p=0.91). Conclusion Use of the PAINAD was not associated with a shorter time to analgesia, although there was a clinically important but non-significant improvement in the cognitively impaired patient group. Further research is needed to address this clinically important and complex issue.

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http://hdl.handle.net/10453/123394