Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study
Eric Albrecht,Patrick Taffé,Bertrand Yersin,Patrick Schoettker,Isabelle Decosterd,Olivier Hugli +5 more
TLDR
Patients' characteristics but physicians' practice variations contributed to oligoanalgesia, a factor often overlooked in analyses of prehospital pain management, and further exploration of the sources of these variations may provide innovative targets for quality improvement programmes to achieve consistent pain relief for trauma victims.Abstract:
Background Prehospital oligoanalgesia is prevalent among trauma victims, even when the emergency medical services team includes a physician. We investigated if not only patients' characteristics but physicians' practice variations contributed to prehospital oligoanalgesia. Methods Patient records of conscious adult trauma victims transported by our air rescue helicopter service over 10 yr were reviewed retrospectively. Oligoanalgesia was defined as a numeric rating scale (NRS) >3 at hospital admission. Multilevel logistic regression analysis was used to predict oligoanalgesia, accounting first for patient case-mix, and then physician-level clustering. The intraclass correlation was expressed as the median odds ratio (MOR). Results A total of 1202 patients and 77 physicians were included in the study. NRS at the scene was 6.9 (1.9). The prevalence of oligoanalgesia was 43%. Physicians had a median of 5.7 yr (inter-quartile range: 4.2–7.5) of post-graduate training and 27% were female. In our multilevel analysis, significant predictors of oligoanalgesia were: no analgesia [odds ratio (OR) 8.8], National Advisory Committee for Aeronautics V on site (OR 4.4), NRS on site (OR 1.5 per additional NRS unit >4), female physician (OR 2.0), and years of post-graduate experience [>4.0 to ≤5.0 (OR 1.3), >3.0 to ≤4.0 (OR 1.6), >2.0 to ≤3.0 (OR 2.6), and ≤2.0 yr (OR 16.7)]. The MOR was 2.6, and was statistically significant. Conclusions Physicians' practice variations contributed to oligoanalgesia, a factor often overlooked in analyses of prehospital pain management. Further exploration of the sources of these variations may provide innovative targets for quality improvement programmes to achieve consistent pain relief for trauma victims.read more
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Improving the management of post-operative acute pain: priorities for change
Winfried Meissner,Flaminia Coluzzi,Dominique Fletcher,Frank J P M Huygen,Bart Morlion,Edmund Neugebauer,Antonio Montes Pérez,Joseph V. Pergolizzi +7 more
TL;DR: Key priorities for improving post-operative pain management were identified in four different areas; introducing acute pain services and increasing their availability towards the 24 hours/day ideal, greater adherence to protocols, increased use of patient-reported outcomes, and greater receptivity to technological advances would help to enhance performance and increase patient satisfaction.
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Emergency Department Contribution to the Prescription Opioid Epidemic
TL;DR: Between 1996 and 2012, opioid prescribing for noncancer patients in the United States significantly increased, and the majority of this growth was attributable to office visits and refills of previously prescribed opioids.
Journal ArticleDOI
Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline.
Annemieke Scholten,Sivera Berben,Alvin Westmaas,Pierre M. van Grunsven,E.T. de Vaal,Pleunie P.M. Rood,Nico Hoogerwerf,Carine J. M. Doggen,Lisette Schoonhoven +8 more
TL;DR: The aim of this study was to assess whether current practice is in compliance with the guideline 'Pain management for trauma patients in the chain of emergency care' from the Netherlands Association for Emergency Nurses, and to evaluate early and initial pain management for adult trauma Patients in emergency care.
Journal ArticleDOI
The role of inhaled methoxyflurane in acute pain management.
TL;DR: Given the limitations of currently available analgesic agents in the prehospital and emergency department settings, the ease of use and portability of methoxyflurane combined with its rapid onset of effective pain relief and favorable safety profile make it a useful nonopioid option for pain management.
Journal ArticleDOI
Analgesic Efficacy, Practicality and Safety of Inhaled Methoxyflurane Versus Standard Analgesic Treatment for Acute Trauma Pain in the Emergency Setting: A Randomised, Open-Label, Active-Controlled, Multicentre Trial in Italy (MEDITA)
Sebastiano Mercadante,Antonio Voza,Sossio Serra,Germana Ruggiano,Giuseppe Carpinteri,Gianfilippo Gangitano,Fabio Intelligente,Elisabetta Bonafede,Antonella Sblendido,Alberto Farina,Amedeo Soldi,Andrea Fabbri +11 more
TL;DR: Methoxyflurane provided superior pain relief to SAT in patients with moderate-to-severe trauma pain and may offer a simple, fast, effective non-opioid treatment option.
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