The assessment and management of acute trauma pain in a Cape Town, South Africa Emergency Centre: A retrospective chart review

TL;DR

This study examines how pain from trauma is managed in a South African emergency center, finding significant gaps in pain assessment and treatment.

Contribution

The study provides empirical evidence on trauma pain management practices in a South African EC, highlighting systemic issues in LMICs.

Findings

Only 32.9% of trauma patients had their pain assessed and documented.

Just 42.3% of patients received analgesia, with long delays in administration.

The findings underscore poor pain management practices in low and middle-income countries.

Abstract

Trauma accounts for over 60,000 deaths annually in South Africa and is also responsible for a high proportion of emergency centre (EC) visits. Up to 91% of trauma patients in the EC experience acute pain, underscoring a critical public health concern, particularly in low and middle-income countries (LMICS), where research indicates poor pain management and a paucity of data. This study aimed to describe trauma pain assessment and management practices in a busy Cape Town EC.

This single-centre retrospective chart review in a high trauma burden EC collected a convenience sample over two weeks in 2024. Data were extracted from the medical records of adult trauma patients presenting to the EC.

A total of 234 patients were included, predominantly male (73.1%), with a median age of 33 (IQR 26–41). Only 32.9% (77) of the patients had their pain assessed and documented, largely only in the triage process, and no patient had their pain reassessed. Furthermore, only 42.3% (99) of patients received analgesia, including opioids administered to 48.5% (48), non-steroidal anti-inflammatories to 45.5% (45), paracetamol to 69.7% (69), and ketamine to 17.2% (17). The time from arrival to the administration of the first analgesia in the EC was documented in 83 patients, with a median time to analgesia of 375 min (IQR 152–611).

This study demonstrates findings consistent with the global crisis of inadequate pain management. It reveals poor pain assessment and management, with prolonged waiting times for analgesia despite various indicators of potential pain severity, highlighting a crucial need for changes in pain management strategies. Training, awareness, and protocols to improve pain management are essential, along with considering nurse-led analgesia at triage.

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