Concomitant Analgesia Use with Intubation in the Emergency Department

Introduction:

The Society of Critical Care Medicine (SCCM) recommends preemptive analgesia with an opiate based regimen prior to many invasive procedures including intubation. Patients who recalled pain had higher incidence of chronic pain, post-traumatic stress disorder, and lower health related quality of life.

Objectives:

The purpose of this study was to determine the prevalence and impact of patient specific factors on frequency of analgesia administration with intubation in the emergency department (ED) at a tertiary care hospital. 

Study Design:

This was an IRB-approved, retrospective, cohort study of 118 patients (100 adult and 18 pediatric) between June 2013 and June 2015.

Methods:

The primary outcome was frequency of analgesic administration within 60 minutes of intubation. Patient specific factors evaluated included Glasgow Coma Scale (GCS) score (responsive vs unresponsive), hemodynamic stability, sedative use and age (pediatric vs adult). The chi square test was used to compare differences between patient specific factors for analgesia administration. 

Results:

The analysis included 118 patients, and sedation was provided to 86.4% while analgesia was provided to 28.8% of patients. No statistically significant difference was found with the following traits: GCS score > 8 versus ≤8 (31% vs 25.5%, p=0.521), patients who were hemodynamically stable versus unstable (24.4% vs 37.5%, p=0.135), no sedative administered compared to receiving a sedative (18.6% vs 30.4%, p=0.3391), or in pediatric versus adult patients (44.4% vs 26%, p=0.156)

Conclusions:

Although there was a high frequency of sedative administration in intubated patients in the ED, there was a low frequency of analgesia administration.  The factor most associated with analgesia administration was pediatric status.  Patients who were responsive, hemodynamically stable, or given a sedative were also more likely to receive analgesia. A paradigm shift to an analgesic-first sedation protocol in the ED is needed to help adhere to current SCCM recommendations and prevent negative long-term health outcomes.