Use of
narcotic analgesics in patients with acute
abdominal pain does not cause delayed misdiagnosis, increases patient comfort and does not suppresses physical examination. The purpose of this study was to determine attitudes anddaily practices of emergency medicine (EM) specialists, residents and faculty members in Turkey on the use of
analgesics in patients with acute
abdominal pain and factors affecting their decisions on the use of
analgesics.
METHODS: A cross-sectional study was performed between November 15, 2013 and January 25, 2014 by conducting a questionnaire to EM physicians working in University Hospitals, Education and Research Hospitals of the Ministry of Health, State Hospitals, and Private Hospitals in Turkey.
RESULTS: A total of 803 questionnaires (participation rate: 47%) were completed. 59.3% (n=470) of the participants were research assistants. 49.5% of the participants reported that
analgesic drugs "suppressed'' physical examination findings. They stated that 90% of the patients "always'' and "often'' requested
analgesics and that 34.6% of surgery consultant physicians "rarely" recommended the use of
analgesics, while 28.7% "never" recommended, and that there was no common policy established together with surgical departments (79.1%). According to the comparison between the EM specialists and residents, residents in the group stating that they would "never'' use
analgesics were higher than specialists in number (p=0.002); residents reported that they administered
analgesics "upon surgical intervention decision", while specialists reported that they administered
analgesics "after patient's examination and treatment plan" (p=0.021); residents reported that
analgesics "suppressed'' physical examination findings, while specialists reported that
analgesics "clarified'' physical examination findings (p<0.0001); residents reported that they did not administer
analgesics "before examination by surgeon'', while specialists reported otherwise (p=0.0001). Senior residents (>24 months) reported that they administered
analgesics "often'' compared to junior residents (p=0.034) and that junior residents believed that the use of
analgesics would "suppress physical examination findings'' at a higher percentage (p=0.002).
CONCLUSION: The rates of use of
analgesics in patients with acute
abdominal pain by EM physicians are very low. The rates of use of
analgesics by EM residents are much lower compared to EM specialists, and they highly believe that
analgesic drugs suppress physical examination findings. Residents tend to administer
analgesic drugs at a later stage. As seniority of residents increases, the rate of
analgesics use and the opinion that
analgesic drugs have no effect on physical examination findings increases.