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<< An Evidence-Based Approach To Traumatic Pain Management In The Emergency Department (Trauma CME)


Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study will be included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

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  6. Todd KH, Sloan EP, Chen C, et al. Survey of pain etiology, management practices and patient satisfaction in two urban emergency departments. CJEM. 2002;4(4):252-256. (Cross-sectional survey; 525 patients)
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  10. * Thomas S, ed. Emergency Department Analgesia. New York: Cambridge University Press; 2008. (Textbook)
  11. * Curtis L, Morrell T. Pain management in the emergency department. Emerg Med Pract. 2006;8(7):1-28. (Review)
  12. * Fink WA Jr. The pathophysiology of acute pain. Emerg Med Clin North Am. 2005;23(2):277-284. (Review)
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  17. DeVellis P, Thomas SH, Wedel SK, et al. Prehospital fentanyl analgesia in air-transported pediatric trauma patients. Pediatr Emerg Care. 1998;14(5):321-323. (Retrospective; 131 patients)
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  33. Pointer JE, Harlan K. Impact of liberalization of protocols for the use of morphine sulfate in an urban emergency medical services system. Prehosp Emerg Care. 2005;9(4):377-381. (Retrospective; 64,340 patients)
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  38. Todd KH, Deaton C, D’Adamo AP, et al. Ethnicity and analgesic practice. Ann Emerg Med. 2000;35(1):11-16. (Retrospective; 217 patients)
  39. Haslam L, Dale C, Knechtel L, et al. Pain descriptors for critically ill patients unable to self-report. J Adv Nurs. 2012;68(5):1082-1089. (Retrospective; 679 subjects)
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  44. Vazirani J, Knott JC. Mandatory pain scoring at triage reduces time to analgesia. Ann Emerg Med. 2012;59(2):134-138. (Prospective before/after; 35,628 patients)
  45. Thomas SH, Andruszkiewicz LM. Ongoing visual analog score display improves emergency department pain care. J Emerg Med. 2004;26(4):389-394. (Prospective randomized controlled; 300 patients)
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  47. Gallagher EJ, Bijur PE, Latimer C, et al. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med. 2002;20(4):287-290. (Prospective observational; 101 patients)
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  49. Gallagher E, Libman M, Bijur P. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med. 2001;38:633-638. (Prospective; 96 patients)
  50. Kelly A. Does the clinically significant difference in visual analog scale pain score vary with gender, age, or cause of pain? Acad Emerg Med. 1998;11:1086-1090. (Prospective; 152 patients)
  51. Fosnocht DE, Chapman CR, Swanson ER, et al. Correlation of change in visual analog scale with pain relief in the ED. Am J Emerg Med. 2005;23(1):55-59. (Prospective observational; 1490 patients)
  52. Bird S, Dickson E. Clinically significant changes in pain along the Visual Analog Scale. Ann Emerg Med. 2001;38:639-643. (Prospective; 77 patients)
  53. Silka P, Roth M, Moreno G. Pain scores improve analgesic administration patterns for trauma patients in the emergency department. Acad Emerg Med. 2004;11:264-270. (Prospective observational; 150 patients)
  54. Bijur P, Latimer C, Gallagher E. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med. 2003;10(4):390-392. (Prospective cohort; 108 patients)
  55. Berthier F, Potel G, Leconte P, et al. Comparative study of methods of measuring acute pain intensity in an ED. Am J Emerg Med. 1998;16(2):132-136. (Comparison; 290 patients)
  56. Kendrick DB, Strout TD. The minimum clinically significant difference in patient-assigned numeric scores for pain. Am J Emerg Med. 2005;23(7):828-832. (Prospective; 354 patients)
  57. Suraseranivongse S, Santawat U, Kraiprasit K, et al. Cross-validation of a composite pain scale for preschool children within 24 hours of surgery. Br J Anaesth. 2001;87(3):400-405. (Cross-validation; 167 pediatric patients)
  58. Merkel S, Voepel-Lewis T, Shayevitz J, et al. The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-297. (Observational; 89 children)
  59. McGrath PA, Seifert CE, Speechley KN, et al. A new analogue scale for assessing children’s pain: an initial validation study. Pain. 1996;64(3):435-443. (Comparison; 104 patients)
  60. Gélinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the Critical-Care Pain Observation Tool and physiologic indicators. Clin J Pain. 2007;23(6):497-505. (Prospective; 55 patients)
  61. Warden V, Hurley A, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. J Am Med Dir Assoc. 2003;4(1)4:9-15. (Prospective; 19 patients)
  62. Paulson-Conger M, Leske J, Maidl C, et al. Comparison of two pain assessment tools in nonverbal critical care patients. Pain Manag Nurs. 2011;12(4):218-224. (Prospective; 100 patients)
  63. Noble VE, Liteplo AS, Nelson BP, et al. The impact of analgesia on the diagnostic accuracy of the sonographic Murphy’s sign. Eur J Emerg Med. 2010;17(2):80-83. (Randomized double-blind placebo-controlled; 30 patients)
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  69. Giannoudis PV, MacDonald DA, Matthews SJ, et al. Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg Br. 2000;82(5):655-658. (Retrospective; 377 patients)
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  71. Hinz B, Cheremina O, Brune K. Acetaminophen (paracetamol) is a selective cyclooxygenase-2 inhibitor in man. FASEB J. 2008;22(2):383-390. (Clinical trial; 5 human volunteers)
  72. McGuinness SK, Wasiak J, Cleland H, et al. A systematic review of ketamine as an analgesic agent in adult burn injuries. Pain Med. 2011;12(10):1551-1558. (Systematic review)
  73. Strayer RJ, Nelson LS. Adverse events associated with ketamine for procedural sedation in adults. Am J Emerg Med. 2008;26(9):985-1028. (Systematic review)
  74. Bisanzo M, Nichols K, Hammerstedt H, et al. Nurse-administered ketamine sedation in an emergency department in rural Uganda. Ann Emerg Med. 2012;59(4):268-275. (Observational; 191 patients)
  75. Sehdev RS, Symmons DA, Kindl K. Ketamine for rapid sequence induction in patients with head injury in the emergency department. Emerg Med Australas. 2006;18(1):37-44. (Systematic review)
  76. Albanese J, Arnaud S, Rey M, et al. Ketamine decreases intracranial pressure and electroencephalographic activity in traumatic brain injury patients during propofol sedation. Anesthesiology. 1997;87(6):1328-1334. (Prospective; 8 patients)
  77. Schmidt A, Oye I, Akeson J. Racemic, S(+)- and R(-)-ketamine do not increase elevated intracranial pressure. Acta Anaesthesiol Scand. 2008;52(8):1124-1130. (Clinical trial; 9 pigs)
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