Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

Siriwardena, A. Niroshan and Asghar, Zahid and Lord, Bill and Pocock, Helen and Phung, Viet-Hai and Foster, Theresa and Williams, Julia and Snooks, Helen and UNSPECIFIED (2018) Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study. The American Journal of Emergency Medicine . ISSN 0735-6757

Full content URL: http://doi.org/10.1016/j.ajem.2018.05.041

Documents
Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study
[img]
[Download]
Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study
https://doi.org/10.1016/j.ajem.2018.05.0
41.
(http://www.sciencedirect.com/science/ar
ticle/pii/S0735675718304194)
[img]
[Download]
[img]
Preview
PDF
ExPLAIN_ajem_accepted.pdf - Whole Document
Available under License Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International.

333kB
[img]
Preview
PDF
1-s2.0-S0735675718304194-main.pdf - Whole Document
Available under License Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International.

289kB
Item Type:Article
Item Status:Live Archive

Abstract

Objective
We aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation.

Methods
We used a cross-sectional design with a 7-day retrospective sample of adults aged 18 years or over requiring primary emergency transport to hospital, excluding patients with Glasgow Coma Scale below 13, in two UK ambulance services. Multivariate multilevel regression using Stata 14 analysed factors independently associated with analgesic administration and a clinically meaningful reduction in pain (≥2 points on 0–10 numerical verbal pain score [NVPS]).

Results
We included data on 9574 patients. At least two pain scores were recorded in 4773 (49.9%) patients. For all models fitted there was no significant relationship between analgesic administration or pain reduction and sex of the patient or ambulance staff.

Reduction in pain (NVPS ≥2) was associated with ambulance crews including at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p < 0.01), with any recorded pain score and suspected cardiac pain (OR 2.2, 95% CI 1.02 to 4.75).

Intravenous morphine administration was also more likely where crews included a paramedic (OR 2.82, 95% CI 1.93 to 4.13, P < 0.01), attending patients aged 51 to 64 years (OR 2.04, 95% CI 1.21 to 3.45, p = 0.01), in moderate to severe (NVPS 4–10) compared with lower levels of pain for any clinical condition group compared with the reference condition.

Conclusion
There was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction.

Keywords:prehospital, Emergency Medical Services, analgesia, pain, paramedic, ambulance
Subjects:B Subjects allied to Medicine > B780 Paramedical Nursing
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Social Science > School of Health & Social Care
ID Code:32209
Deposited On:26 Jun 2018 21:54

Repository Staff Only: item control page