急诊科急性腹痛标准化疼痛管理方案的有效性：系统回顾和荟萃分析。

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-07-16 DOI:10.1016/j.jemermed.2025.07.027

Fahim Kanani MD , Nir Messer MD , Majd Khalil MD , Eduard Khabarov MD , Narmin Zoabi MD

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引用次数: 0

摘要

背景：急性腹痛在急诊科（ED）的表现中占相当大的比例，但由于历史上对掩盖诊断的担忧，疼痛管理仍然不理想。本系统综述全面评估了不同腹部病理的标准化疼痛管理方案。目的：与常规治疗相比，评估标准化疼痛管理方案在减少到镇痛时间和改善因内脏、胆道、肾脏或骨盆源性急性腹痛就诊的成人急诊科的疼痛缓解结果方面的有效性。方法：系统检索2000年1月1日至2025年1月31日的PubMed/MEDLINE、Cochrane Library和Web of Science。符合条件的研究包括急诊科急性腹痛的成人（≥18岁），比较标准化方案（护士发起、临床途径、患者控制镇痛、多模式方法）和常规护理。主要观察指标为首次镇痛时间。次要结果包括疼痛减轻、患者满意度、指南依从性和诊断准确性。随机对照试验采用Cochrane rob2评价偏倚风险，观察性研究采用Newcastle-Ottawa量表评价偏倚风险。随机效应荟萃分析采用综合敏感性分析。结果：在621份确定的记录中，47项研究（n = 8347例患者）符合纳入标准。meta分析（15项研究，n = 3241）显示标准化方案显著减少了镇痛时间：合并效应大小d = 0.54(95%可信区间[CI]: 0.41-0.67)，减少42.7%（绝对37.3分钟）。疼痛强度降低（18项研究，n = 3892）显示出显著改善：标准化平均差异(SMD) -0.76 （95% CI: -0.89至-0.63）。患者满意度持续提高（12项研究，风险比[RR] 1.43, 95% CI: 1.28-1.59）。诊断准确性未受影响（8项研究，RR 0.98, 95% CI: 0.94-1.02）。亚组分析证实了所有病理的益处，包括胆道和盆腔疾病。结论：标准化的疼痛管理方案在减少所有急性腹部病理的镇痛时间和改善疼痛缓解方面显示出强大的有效性，而不影响诊断的准确性。这些发现明确地驳斥了历史上的担忧，并支持在全球急诊科立即实施。

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Effectiveness of Standardized Pain Management Protocols for Acute Abdominal Pain in Emergency Departments: A Systematic Review and Meta-Analysis

Background

Acute abdominal pain constitutes a substantial proportion of emergency department (ED) presentations, yet pain management remains suboptimal due to historical concerns about masking diagnoses. This systematic review comprehensively evaluates standardized pain management protocols across diverse abdominal pathologies.

Objectives

To assess the effectiveness of standardized pain management protocols compared to usual care in reducing time to analgesia and improving pain relief outcomes for adults presenting to EDs with acute abdominal pain of visceral, biliary, renal, or pelvic origin.

Methods

We systematically searched PubMed/MEDLINE, Cochrane Library, and Web of Science from January 1, 2000, to January 31, 2025. Eligible studies included adults (≥18 years) with acute abdominal pain in ED settings, comparing standardized protocols (nurse-initiated, clinical pathways, patient-controlled analgesia, multimodal approaches) to usual care. Primary outcome was time to first analgesia. Secondary outcomes encompassed pain reduction, patient satisfaction, guideline adherence, and diagnostic accuracy. Risk of bias was assessed using Cochrane ROB-2 for randomized controlled trials and Newcastle-Ottawa Scale for observational studies. Random-effects meta-analyses were conducted with comprehensive sensitivity analyses.

Results

From 621 identified records, 47 studies (n = 8347 patients) met inclusion criteria. Time to analgesia meta-analysis (15 studies, n = 3241) demonstrated substantial reduction with standardized protocols: pooled effect size d = 0.54 (95% confidence interval [CI]: 0.41–0.67), representing 42.7% reduction (37.3 minutes absolute). Pain intensity reduction (18 studies, n = 3892) showed significant improvement: standardized mean differences (SMD) −0.76 (95% CI: −0.89 to −0.63). Patient satisfaction improved consistently (12 studies, risk ratios [RR] 1.43, 95% CI: 1.28–1.59). Diagnostic accuracy remained unaffected (8 studies, RR 0.98, 95% CI: 0.94–1.02). Subgroup analyses confirmed benefits across all pathologies, including biliary and pelvic conditions specifically.

Conclusions

Standardized pain management protocols demonstrate robust effectiveness in reducing time to analgesia and improving pain relief across all acute abdominal pathologies without compromising diagnostic accuracy. These findings definitively refute historical concerns and support immediate implementation in emergency departments globally.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine