Mecklenburg EMS Agency,Charlotte,North CarolinaUSA.
Prehosp Disaster Med. 2014 Aug;29(4):344-9. doi: 10.1017/S1049023X14000594. Epub 2014 Jun 19.
Emergency Medical Services (EMS) professionals frequently care for patients experiencing acute pain. Analgesics are critical in patient comfort and satisfaction levels during the treatment of acute pain. The objective of this study was to assess the frequency of pain management in patients suffering a fall, the documented pain score, and the location of their injuries. It was hypothesized that the frequency of analgesia administration was low and would be associated with injury location.
This was a retrospective review of patients presenting with a complaint of an injury from a fall transported by a single municipal EMS system. Administration of analgesia was the primary outcome variable, with pain severity, injury location, age, gender, race, and distance of fall the independent variables of interest. Pain severity was assessed using a 0-10 scale. Injury location was defined as head/neck, extremities, back, and hip. Patients were deemed ineligible for analgesia, according to local protocol, if they reported chest or abdominal pain, or were hemodynamically unstable as determined by an assessment of pulse and blood pressure.
There were 1,200 patients who were classified as having injuries suffered from a fall, with 76 (6.3%) ineligible for analgesia. Ninety-two (8.2%) patients received analgesia, and they had a mean recorded pain score of 9.1 (95% CI, 8.7-9.5), which was higher than those who did not receive analgesia (5.8; 95% CI, 5.5-6.2). Analgesia administration was associated with injury location; patients experiencing an extremity injury (OR = 13.23; 95% CI, 5.58-31.36; P < .001) or hip injury (OR = 11.65; 95% CI, 4.64-29.24; P < .001) had increased odds of analgesia administration compared to those with head/neck injury. The odds of analgesia administration were decreased for black patients (OR = 0.19; 95% CI, 0.08-0.44; P < .001) when compared to white patients.
Analgesia administration was provided to 10% of eligible patients, and was associated with injury location. Of concern was the number of patients who suffered a fall and did not receive a documented pain score. The results from this study indicated a need for education relating to pain management in patients suffering a fall.
急救医疗服务（EMS）专业人员经常照顾急性疼痛的患者。在治疗急性疼痛时，镇痛剂对于患者的舒适度和满意度水平至关重要。本研究的目的是评估在因跌倒而接受治疗的患者中疼痛管理的频率、记录的疼痛评分以及受伤部位。假设镇痛剂的给药频率较低，并且与受伤部位有关。
这是对单个市政 EMS 系统转运的因跌倒而受伤的患者进行的回顾性研究。镇痛剂的使用是主要的观察结果变量，疼痛严重程度、受伤部位、年龄、性别、种族和跌倒距离是感兴趣的独立变量。疼痛严重程度使用 0-10 分制进行评估。受伤部位定义为头部/颈部、四肢、背部和臀部。根据当地协议，如果患者报告胸痛或腹痛，或脉搏和血压评估确定其血流动力学不稳定，则认为患者不符合镇痛剂使用条件。
共有 1200 名患者被归类为因跌倒而受伤，其中 76 名（6.3%）不符合镇痛剂使用条件。92 名（8.2%）患者接受了镇痛剂，他们的记录疼痛评分为 9.1（95%置信区间，8.7-9.5），高于未接受镇痛剂的患者（5.8；95%置信区间，5.5-6.2）。镇痛剂的使用与受伤部位有关；与头部/颈部受伤的患者相比，四肢受伤（OR=13.23；95%置信区间，5.58-31.36；P<.001）或臀部受伤（OR=11.65；95%置信区间，4.64-29.24；P<.001）的患者接受镇痛剂的几率更高。与白人患者相比，黑人患者（OR=0.19；95%置信区间，0.08-0.44；P<.001）接受镇痛剂的几率降低。
10%的符合条件的患者接受了镇痛剂治疗，且与受伤部位有关。令人担忧的是，许多跌倒的患者没有记录疼痛评分。本研究的结果表明，需要对跌倒患者的疼痛管理进行教育。
