{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:46:07Z","timestamp":1791222367428,"version":"4.1.0"},"reference-count":86,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T00:00:00Z","timestamp":1708560000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Across the world, 25\u201329% of the population suffer from pain. Pain is the most frequent reason for an emergency department (ED) visit. This symptom is involved in approximately 70% of all ED visits. The effective management of acute pain with adequate analgesia remains a challenge, especially for severe pain. Intravenous (IV) morphine protocols are currently indicated. These protocols are based on patient-reported scores, most often after an immediate evaluation of pain intensity at triage. However, they are not systematically prescribed. This aspect could be explained by the fact that physicians individualize opioid pain management for each patient and each care pathway to determine the best benefit\u2013risk balance. Few data are available regarding bedside organizational factors involved in this phenomenon.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to analyze the organizational factors associated with no IV morphine prescription in a standardized context of opioid management in a tertiary-care ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A 3-month prospective study with a case\u2013control design was conducted in a French university hospital ED. This study focused on factors associated with protocol avoidance despite a visual analog scale (VAS) \u226560 or a numeric rating scale (NRS) \u22656 at triage. Pain components, physician characteristics, patient epidemiologic characteristics, and care pathways were considered. Qualitative variables (percentages) were compared using Fisher\u2019s exact test or the chi-squared tests. Student\u2019s t-test was used to compare continuous variables. The results were expressed as means with their standard deviation (SD). Factors associated with morphine avoidance were identified by logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 204 patients were included in this study. A total of 46 cases (IV morphine) and 158 controls (IV morphine avoidance) were compared (3:1 ratio). Pain patterns and patient\u2019s epidemiologic characteristics were not associated with an IV morphine prescription. Regarding NRS intervals, the results suggest a practice disconnected from the patient\u2019s initial self-report. IV morphine avoidance was significantly associated with care pathways. A significant difference between the IV morphine group and the IV morphine avoidance group was observed for \u201cself-referral\u201d [adjusted odds ratio (aOR): 5.11, 95% CIs: 2.32\u201312.18, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001] and patients\u2019 trajectories (Fisher\u2019s exact test; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001), suggesting IV morphine avoidance in ambulatory pathways. In addition, \u201cjunior physician grade\u201d was associated with IV morphine avoidance (aOR: 2.35, 95% CIs: 1.09\u20135.25, <jats:italic>p<\/jats:italic>\u2009=\u20090.03), but physician gender was not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This bedside case\u2013control study highlights that IV morphine avoidance in the ED could be associated with ambulatory pathways. It confirms the decreased choice of \u201cNRS-only\u201d IV morphine protocols for all patients, including non-trauma patterns. Modern pain education should propose new tools for pain evaluation that integrate the heterogeneity of ED pathways.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1352833","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T11:56:32Z","timestamp":1708602992000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Severe pain management in the emergency department: patient pathway as a new factor associated with IV morphine prescription"],"prefix":"10.3389","volume":"12","author":[{"given":"Virginie 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