Views of Emergency Physicians Working in University Hospitals in Turkey Regarding Use of Analgesics in Patients with Acute Abdominal Pain and Factors Affecting Use of Analgesics

Abstract

Objective: The objective is to investigate factors affecting the frequency and use of analgesics in patients with acute abdominal pain by emergency physicians in Turkey. Material and Methods: The cross-sectional analytic study was performed between June and September 2006. The population of the study included the attending emergency physicians and residents at university hospitals in Turkey. The surveys were returned by mail after having been filled out by twenty-four departments participating in the study. Results: Two hundred sixty three of 322 emergency physicians completed the survey (coverage rate: 81.6%). Twenty five percent (n=66) of 263 physicians were emergency medicine specialists. Fifty four percent (n=143) of the participants stated that the use of analgesics “repressed the physical examination findings”. Rates in analgesic use also increased in parallel with increases in physicians' ages and were found statistically significant. Moreover, a regional difference among rates of analgesic use was observed (p<0.05). Conclusion: Rates of administering analgesics for patients with acute abdominal pain by university emergency physicians in Turkey are quite low. Physicians' ages, regional location of the hospitals, physical examination findings, radiological examination results, quality and level of pain and received diagnosis are the factors affecting the decision-making process in administering analgesics.

Keywords

• Abdominal pain, analgesics, emergency physicians, survey

Views of Emergency Physicians Working in University Hospitals in Turkey Regarding Use of Analgesics in Patients with Acute Abdominal Pain and Factors Affecting Use of Analgesics

Öz

Kaynakça

1. Howell JM, Eddy OL, Lukens TW, Thiessen ME, Weingart SD, Decker WW, American College of Emergency Physicians. Clini- cal policy: critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Ann Emerg Med 2010; 55: 71-116. [CrossRef]
2. Attard AR, Corlett MJ, Kidner NJ, Leslie AP, Fraser IA. Safety of early pain relief for acute abdominal pain. BMJ 1992;305:554-6. [CrossRef]
3. Zoltie N, Cust MP. Analgesia in the acute abdomen. Ann R Coll Surg Engl 1986;68:209-10. [CrossRef]
4. Pace S, Burke TF. Intravenous morphine for early pain relief in pa- tients with acute abdominal pain. Acad Emerg Med 1996;3:1086-92. [CrossRef]
5. LoVecchio F, Oster N, Sturmann K, Nelson LS, Flashner S, Finger R. The use of analgesics in patients with acute abdominal pain. J Emerg Med 1997;15:775-9. [CrossRef]
6. Thomas SH, Silen W, Cheema F, Reisner A, Aman S, Goldstein JN, et al. Effects of morphine analgesia on diagnostic accuracy in Emer- gency Department patients with abdominal pain: a prospective, ran- domized trial. J Am Coll Surg 2003;196:18-31. [CrossRef]
7. Vermeulen B, Morabia A, Unger PF, Goehring C, Grangier C, Skljarov I, et al. Acute appendicitis: infl uence of early pain re- lief on the accuracy of clinical and US Ş ndings in the decision to operate--a randomized trial. Radiology 1999;210:639-43.
8. Mahadevan M, Graff L. Prospective randomized study of analge- sic use for ED patients with right lower quadrant abdominal pain. Am J Emerg Med 2000;18:753-6. [CrossRef]

9. Kim MK, Strait RT, Sato TT, Hennes HM. A randomized clinical trial of analgesia in children with acute abdominal pain. Acad Emerg Med 2002;9:281-7. [CrossRef]
10. Sinert R, Blackstock U. Evidence-based emergency medicine/ systematic review abstract. Analgesia in patients with acute ab- dominal pain: to withhold or not to withhold? Ann Emerg Med 2008;52:563-6. [CrossRef]
11. Wolfe JM, Lein DY, Lenkoski K, Smithline HA. Analgesic administra- tion to patients with an acute abdomen: a survey of emergency medi- cine physicians. Am J Emerg Med 2000;18:250-3. [CrossRef]
12. Graber MA, Ely JW, Clarke S, Kurtz S, Weir R. Informed consent and general surgeons’ attitudes toward the use of pain medi- cation in the acute abdomen. Am J Emerg Med 1999;17:113-6. [CrossRef]
13. Kim MK, Galustyan S, Sato TT, Bergholte J, Hennes HM. Anal- gesia for children with acute abdominal pain: a survey of pedi- atric emergency physicians and pediatric surgeons. Pediatrics 2003;112:1122-6. [CrossRef]
14. Hashikawa C, Burke TF, Pallin DJ, Briggs-Malonson M. Analgesia administration for acute abdominal pain: a survey of emergency physicians. Ann Emerg Med 2007;50:91-2. [CrossRef]
15. Goldman RD, Narula N, Klein-Kremer A, Finkelstein Y, Rogovik AL. Predictors for opioid analgesia administration in children with abdominal pain presenting to the emergency department. Clin J Pain 2008;24:11-5. [CrossRef]
16. Rupp T, Delaney KA. Inadequate analgesia in emergency medi- cine. Ann Emerg Med 2004;43:494-503. [CrossRef]
17. Todd KH, Deaton C, D’Adamo AP, Goe L. Ethnicity and analgesic practice. Ann Emerg Med 2000;35:11-6. [CrossRef]
18. Ranji SR, Goldman LE, Simel DL, Shojania KG. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA 2000;296:1764-74.