Factors associated with unoffered trauma analgesia in critical care transport

• Published in: The American journal of emergency medicine 2009, Vol.27 (1), p.49-54
• Main Authors: Frakes, Michael A., APRN, MS, EMTP, Lord, Wendy R., RN, BSN, EMTP, Kociszewski, Christine, EMTP, MPH, Wedel, Suzanne K., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analgesia; Analgesics; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Clinical death. Palliative care. Organ gift and preservation; Corporate culture; Critical Care - methods; Documentation; Emergency; Emergency medical care; Female; Hospitals; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Pain; Pain - drug therapy; Pain - etiology; Pain management; Retrospective Studies; Transportation of Patients; Variance analysis; Wounds and Injuries - complications; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2008.01.005

Abstract Objective Pain relief is a key out-of-hospital patient care outcome measure, yet many trauma patients do not receive prompt analgesia. Although specialty critical care transport (CCT) teams provide analgesia frequently, successfully, and safely, there is still a population of CCT patients to whom analgesia is not offered. We report the factors associated with non-administration of analgesia and with analgesic effect in trauma patients cared for by CCT teams. Methods This is a retrospective review of consecutive transport records for nonintubated trauma patients with self-reported pain during specialty CCT care. Patient demographics, CCT interventions, clinical traits, and pain self-reports are measured. Means comparisons are made with a univariate analysis of variance, and odds ratios (ORs) with 95% confidence intervals (CIs) are reported for between-group comparisons. Results Of the 209 enrolled patients, 169 (80.9%; 95% CI, 75.6%-86.2%) were treated (147 received analgesia and 22 offered analgesia but refused). In patients with pain scale documentation (n = 145), self-reported pain on a scale from 0 to 10 decreased from 6.8 ± 2.8 to 3.3 ± 2.4 ( P ≤ .001). Three factors were associated with absence of analgesic administration: initial pain level (OR for administration, 0.13; 95% CI, 0.04-0.40), pain scale documentation (OR, 0.31; 95% CI, 0.15-0.60), and transport program (OR, 0.36; 95% CI, 0.17-0.74). No clinical factor was associated with analgesia effectiveness in treated patients. Conclusion The identified factors may represent opportunities for CCT teams to optimize analgesic treatment.