Evidence map›Paper›PMID 28601270›Full record

Trial reportAnnals of emergency medicine2017

Comparative Effectiveness of Patient-Controlled Analgesia for Treating Acute Pain in the Emergency Department.

Polly E Bijur, Angela M Mills, Andrew K Chang, Deborah White, Andrew Restivo, Shaun Persaud, Clyde B Schechter, E John Gallagher, Adrienne J Birnbaum

Abstract readPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of emergency medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
3.7field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 18 citations in OpenAlex.

  1. Review
  2. Article
  3. Observational
  4. Review
  5. Article
  6. Acute Pain Management in the Year 2018-A Review.Journal of acute medicine · 2018
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Polly E BijurDepartment of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY. Electronic address: polly.bijur@einstein.yu.edu.
Angela M MillsDepartment of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Andrew K ChangDepartment of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY.
Deborah WhiteDepartment of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY.
Andrew RestivoDepartment of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY.
Shaun PersaudDepartment of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY.
Clyde B SchechterDepartment of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.
E John GallagherDepartment of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY.
Adrienne J BirnbaumDepartment of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY.
Albert Einstein College of Medicine · USUniversity of Pennsylvania · US

Funding

Effectiveness and Feasibility of Patient Controlled Analgesia in the EDR01NR013980 · NINR · ALBERT EINSTEIN COLLEGE OF MEDICINE, INC · PI BIJUR, POLLY ELLEN, BIRNBAUM, ADRIENNE JEANNE · 2012 to 2014
$1.1M
NINR NIH HHS R01 NR013980
6 · The paper itself

Abstract

STUDY

objectiveWe assess the effectiveness of patient-controlled analgesia in the emergency department (ED). We hypothesized that decline in pain intensity from 30 to 120 minutes after initial intravenous opioid administration is greater in patients receiving morphine by patient-controlled analgesia compared with usual care and would differ by a clinically significant amount.

methodThis was a pragmatic randomized controlled trial of patient-controlled analgesia and usual care (opioid and dose at physician's discretion) in 4 EDs. Entry criteria included age 18 to 65 years and acute pain requiring intravenous opioids. The primary outcome was decline in numeric rating scale pain score 30 to 120 minutes postbaseline. Secondary outcomes included satisfaction, time to analgesia, adverse events, and patient-controlled analgesia pump-related problems. We used a mixed-effects linear model to compare rate of decline in pain (slope) between groups. A clinically significant difference between groups was defined as a difference in slopes equivalent to 1.3 numeric rating scale units.

resultsSix hundred thirty-six patients were enrolled. The rate of decline in pain from 30 to 120 minutes was greater for patients receiving patient-controlled analgesia than usual care (difference=1.0 numeric rating scale unit; 95% confidence interval [CI] 0.6 to 1.5; P<.001) but did not reach the threshold for clinical significance. More patients receiving patient-controlled analgesia were satisfied with pain management (difference=9.3%; 95% CI 3.3% to 15.1%). Median time to initial analgesia was 15 minutes longer for patient-controlled analgesia than usual care (95% CI 11.4 to 18.6 minutes). There were 7 adverse events in the patient-controlled analgesia group and 1 in the usual care group (difference=2.0%; 95% CI 0.04% to 3.9%), and 11 pump-programming errors.

conclusionThe findings of this study do not favor patient-controlled analgesia over usual ED care for acute pain management.

Indexed as

Emergency Service, HospitalSelf AdministrationAcute PainAdultAnalgesicsAnalgesics, OpioidFemaleHumansMalePain ManagementPain MeasurementAnalgesicsAnalgesics, Opioid

Identifiers

PMID28601270
PMCPMC5698131
OpenAlexW2626468563

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.