Intervention Study with Algoplus ® : A Pain Behavioral Scale for Older Patients in the Emergency Department

Objectives Evaluation of acute pain is often difficult in older patients admitted to the Emergency Department ( ED ), and self‐evaluation of pain is not always possible. This observational study evaluates how the systematic use of Algoplus ® , a validated behavioral scale, could improve pain management of older persons admitted to the ED . Method The intervention study ( NCT 02258503) took place in 4 steps in the ED , University Hospital Clermont‐Ferrand, France. Pain assessment and analgesics prescription were collected from medical files for 3 months. For 6 months, the whole staff of the ED were trained on pain assessment and to use Algoplus ® scale (3—same as step 1). To evaluate the intervention, pain assessment and analgesics prescription were compared before and after implementation by 2‐sided tests with a type I error set at α = 0.05. Results The intervention led to systematic pain evaluation with Algoplus ® in 100% of patients (≥ 75 years old, n = 434) and was completed by numeric rating scale ( NRS ) and other evaluations. Pearson's correlation between NRS ≥ 3 and Algoplus ® < 2 was 0.61. Prescription of analgesics (+6%) especially opioids increased nonsignificantly but was similar for all patients whatever the evaluation. Conclusions The systematic introduction of Algoplus ® scale in the ED allowed a change in practice by improving evaluation and management of pain in patients ≥ 75 years old, especially when difficult to be evaluated. Algoplus ® allowed an objective levelling of analgesics prescription in all admitted patients. It also promoted field action to improve pain management in ED .