Hewes Hilary A, Dai Mengtao, Mann N Clay, Baca Tanya, Taillac Peter
Prehosp Emerg Care. 2018 Mar-Apr;22(2):189-197. doi: 10.1080/10903127.2017.1367444. Epub 2017 Sep 28.
Historically, pain management in the prehospital setting, specifically pediatric pain management, has been inadequate despite many EMS (emergency medical services) transports related to traumatic injury with pain noted as a symptom. The National Emergency Services Information System (NEMSIS) database offers the largest national repository of prehospital data, and can be used to assess current patterns of EMS pain management across the country.
To analyze prehospital management of pain using NEMSIS data, and to assess if variables such as patient age and/or race/ethnicity are associated with disparity in pain treatment.
DESIGN/SETTING/PARTICIPANTS: A retrospective descriptive study over a three-year period (2012-2014) of the NEMSIS database for patients evaluated for three potentially painful medical impressions (fracture, burn, penetrating injury) to assess the presence of documented pain as a symptom, and if patients received treatment with analgesic medications. Results were analyzed according to type of pain medication given, age categories, and race/ethnicity of the patients.
Percentage of EMS transports documenting the three painful impressions that had pain documented as a symptom, received any of the six pain medications, and the disparity in documentation and treatment by age and race/ethnicity.
There were 276,925 EMS records in the NEMSIS database that met inclusion criteria. Pain was listed as a primary or associated symptom for 29.5% of patients, and the youngest children (0-3 years) were least likely to have pain documented as a symptom (14.6%). Only 15.6% of all activations documented the receipt of prehospital pain medications. Children (<15 years) received pain medication 14.8% [95% CI 14.33, 15.34] of the time versus adults (≥15 years) 15.6% [95% CI 15.48, 15.76, p = 0.004]. Morphine and fentanyl were the most commonly administered medications to all age groups. Black patients were less likely to receive pain medication than other racial groups.
Documentation of pain as a symptom and pain treatment continue to be infrequent in the prehospital setting in all age groups, especially young children. There appears to be a racial disparity with Black patients less often treated with analgesics. The broad incorporation of national NEMSIS data suggests that these inadequacies are a widespread challenge deserving further attention.
从历史上看，尽管许多与创伤性损伤相关的紧急医疗服务（EMS）转运都将疼痛列为症状，但院前环境中的疼痛管理，尤其是儿科疼痛管理一直不足。国家紧急服务信息系统（NEMSIS）数据库提供了最大的全国院前数据存储库，可用于评估全国EMS疼痛管理的当前模式。
使用NEMSIS数据分析院前疼痛管理，并评估患者年龄和/或种族/民族等变量是否与疼痛治疗差异相关。
设计/设置/参与者：对NEMSIS数据库进行为期三年（2012 - 2014年）的回顾性描述性研究，研究对象为因三种可能引起疼痛的医疗情况（骨折、烧伤、穿透伤）接受评估的患者，以评估记录在案的疼痛症状的存在情况，以及患者是否接受了镇痛药治疗。根据给予的止痛药类型、年龄类别和患者的种族/民族对结果进行分析。
记录有三种疼痛情况且将疼痛记录为症状的EMS转运患者的百分比，接受六种止痛药中任何一种治疗的患者百分比，以及按年龄和种族/民族划分的记录和治疗差异。
NEMSIS数据库中有276,925条EMS记录符合纳入标准。29.5%的患者将疼痛列为主要或相关症状，最小的儿童（0 - 3岁）最不可能将疼痛记录为症状（14.6%）。所有出诊记录中只有15.6%记录了院前使用止痛药的情况。儿童（<15岁）接受止痛药治疗的时间为14.8% [95%置信区间14.33, 15.34]，而成人（≥15岁）为15.6% [95%置信区间15.48, 15.76，p = 0.004]。吗啡和芬太尼是所有年龄组中最常用的药物。黑人患者比其他种族群体更不可能接受止痛药治疗。
在所有年龄组的院前环境中，将疼痛记录为症状和进行疼痛治疗的情况仍然很少见，尤其是幼儿。黑人患者在接受镇痛药治疗方面似乎存在种族差异。全国NEMSIS数据的广泛纳入表明，这些不足是一个普遍存在的挑战，值得进一步关注。
