Pediatric Emergency Department.
Rappaport Faculty of Medicine, Technion-institute of Technology, Haifa, Israel.
Clin J Pain. 2020 May;36(5):365-370. doi: 10.1097/AJP.0000000000000813.
Triage nurse-initiated analgesia (TNIA) has been shown to be associated with decreased time to the provision of analgesia and improved patient satisfaction. We examined variables that influence the provision of analgesia in a pediatric emergency department that uses TNIA.
A 4-year retrospective cohort study of all children with triage pain scores ≥1 was conducted. Data on demographics and patients' and nurses' characteristics were collected. Logistic regression analyses were used to examine the effect of multiple variables on the provision of any analgesia and opioid analgesia.
Overall, 28,746 children had triage pain scores ≥1; 14,443 (50.2%) patients received analgesia of any type and 1888 (6.6%) received opioid analgesia. Mean time to any analgesia was 8.0±3.7 minutes. Of the 9415 patients with severe pain, 1857 (19.7%) received opioid analgesia. Age, sex, hourly number of patients waiting to be triaged, and nurse experience were not associated with the provision of any analgesia or opioid analgesia. Severe pain had the highest odds ratios (ORs) for the provision of any analgesia and opioid analgesia (7.7; 95% confidence interval [CI]: 7.1-8.2 and 22.8; 95% CI: 18.1-28.8, respectively). Traumatic injury and time-to-triage <8 minutes were associated with the provision of opioid analgesia (OR: 4.7; 95% CI: 4.2-5.2 and OR: 1.6; 95% CI: 1.5-1.8, respectively).
TNIA yielded a short time to analgesia, but rates of any analgesia and opioid analgesia were low. Several variables associated with the provision of any analgesia and opioid analgesia were identified. Our findings provide evidence to guide future educational programs in this area.
分诊护士启动的镇痛（TNIA）已被证明与镇痛提供时间的缩短和患者满意度的提高有关。我们检查了在使用 TNIA 的儿科急诊室中影响镇痛提供的变量。
对所有分诊疼痛评分≥1 的儿童进行了一项为期 4 年的回顾性队列研究。收集了人口统计学数据以及患者和护士的特征数据。使用逻辑回归分析来检查多个变量对提供任何镇痛和阿片类镇痛的影响。
总体而言，有 28746 名儿童的分诊疼痛评分≥1；14443 名（50.2%）患者接受了任何类型的镇痛，1888 名（6.6%）患者接受了阿片类镇痛。任何镇痛的平均时间为 8.0±3.7 分钟。在 9415 名有严重疼痛的患者中，1857 名（19.7%）患者接受了阿片类镇痛。年龄、性别、每小时等待分诊的患者数量以及护士经验与提供任何镇痛或阿片类镇痛无关。严重疼痛与提供任何镇痛和阿片类镇痛的可能性最高（OR：7.7；95%置信区间[CI]：7.1-8.2 和 22.8；95% CI：18.1-28.8）。创伤性损伤和分诊时间<8 分钟与阿片类镇痛的提供相关（OR：4.7；95% CI：4.2-5.2 和 OR：1.6；95% CI：1.5-1.8）。
TNIA 实现了短时间内提供镇痛，但任何镇痛和阿片类镇痛的比例都较低。确定了与提供任何镇痛和阿片类镇痛相关的几个变量。我们的研究结果为该领域的未来教育计划提供了证据。
