Spilman Sarah K, Lechtenberg Garret T, Hahn K Danielle, Fuchsen Elizabeth A, Olson Sherry D, Swegle James R, Vaudt Cory C, Sahr Sheryl M
Trauma Services, UnityPoint Health, Des Moines, IA, USA.
General Surgery Residency Program, Iowa Methodist Medical Center, Des Moines, IA, USA.
Injury. 2016 Sep;47(9):2018-24. doi: 10.1016/j.injury.2016.03.012. Epub 2016 Mar 16.
Prior research has documented the inadequacy of pain management for trauma patients in the emergency department (ED), with rates of pain assessment and opioid administration averaging about 50%. Such rates, however, may be misleading and do not adequately capture the complexity of pain management practices in a trauma population. The goal of the study was to determine if pain was undertreated at the study hospital or if patient acuity explained the timing and occurrence of pain treatment in the prehospital setting and the ED.
A retrospective study was performed at a Level 1 adult trauma centre in the Midwest. The trauma registry was used to identify patients who received a trauma activation during the study period (June-November 2012; N=313). Using the first set of patient vitals and ISS, patients were grouped into three categories: physiologically stable with low injury severity (n=132); physiologically stable with moderate to severe injury (n=122); and physiologically unstable with severe injury (n=56). Differences were assessed with Kruskal-Wallis and chi-square tests.
Patients who were physiologically unstable were the least likely to receive a standardised pain assessment and the least likely to receive an opioid in the ED. Patients who were physiologically stable at entry to the ED but sustained a severe injury were the most likely to receive an opioid. Time to first pain assessment and time to first opioid did not differ by patient acuity.
Results confirm that patient acuity greatly affects the ability to effectively and appropriately manage pain in the initial hours after injury. This study contributes to the literature by noting areas for improvement but also in explaining why delaying pain treatment may be appropriate in certain patient populations.
先前的研究记录了急诊科（ED）中创伤患者疼痛管理的不足，疼痛评估率和阿片类药物使用率平均约为50%。然而，这样的比率可能具有误导性，无法充分体现创伤人群疼痛管理实践的复杂性。本研究的目的是确定在研究医院中疼痛是否未得到充分治疗，或者患者的病情严重程度是否可以解释院前环境和急诊科疼痛治疗的时机及发生情况。
在中西部的一家一级成人创伤中心进行了一项回顾性研究。使用创伤登记册确定在研究期间（2012年6月至11月；N = 313）接受创伤激活的患者。根据患者的第一组生命体征和损伤严重度评分（ISS），将患者分为三类：生理稳定且损伤程度低（n = 132）；生理稳定且损伤程度为中度至重度（n = 122）；生理不稳定且损伤严重（n = 56）。采用Kruskal-Wallis检验和卡方检验评估差异。
生理不稳定的患者在急诊科接受标准化疼痛评估的可能性最小，接受阿片类药物治疗的可能性也最小。进入急诊科时生理稳定但遭受严重损伤的患者最有可能接受阿片类药物治疗。首次疼痛评估时间和首次使用阿片类药物的时间在不同病情严重程度的患者中并无差异。
结果证实，患者的病情严重程度在很大程度上影响受伤后最初几小时内有效且适当地管理疼痛的能力。本研究不仅指出了需要改进的方面，还解释了为何在某些患者群体中延迟疼痛治疗可能是合适的，从而为该领域的文献做出了贡献。
