Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England, United Kingdom; East Midlands Ambulance Service NHS Trust, Nottingham, England, United Kingdom.
Community and Health Research Unit, University of Lincoln, Lincoln, England, United Kingdom.
Am J Emerg Med. 2019 Feb;37(2):266-271. doi: 10.1016/j.ajem.2018.05.041. Epub 2018 May 23.
We aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation.
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]).
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.
There was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction.
我们旨在确定患者（年龄、性别、病情）和护理人员（性别、角色）因素如何影响院前镇痛管理和疼痛缓解。
我们使用了横断面设计，对两家英国救护机构中需要进行主要急诊转运至医院的 18 岁及以上成年人进行了为期 7 天的回顾性样本调查，排除格拉斯哥昏迷量表（Glasgow Coma Scale）评分低于 13 的患者。使用 Stata 14 进行多变量多层回归分析，以确定与镇痛管理和疼痛明显缓解（0-10 数字口述疼痛评分[NVPS]≥2 分）相关的独立因素。
我们纳入了 9574 例患者的数据。在至少记录了两次疼痛评分的 4773 例患者中（49.9%）。对于所有拟合的模型，患者或救护人员的性别与镇痛管理或疼痛缓解均无显著关系。疼痛缓解（NVPS≥2）与包括至少一名护理人员的救护人员有关（优势比[OR] 1.52，95%置信区间[CI] 1.14-2.04，p<0.01），与任何记录的疼痛评分和疑似心脏疼痛有关（OR 2.2，95%CI 1.02-4.75）。在包括护理人员的情况下，静脉注射吗啡的可能性也更高（OR 2.82，95%CI 1.93-4.13，P<0.01），且护理人员治疗年龄在 51-64 岁的患者（OR 2.04，95%CI 1.21-3.45，p=0.01）和中度至重度疼痛（NVPS 4-10）的患者也高于任何临床状况组的轻度疼痛患者。
患者性别或救护人员性别或等级与镇痛管理或疼痛缓解之间没有关联。
