Prehosp Emerg Care. 2021 Nov-Dec;25(6):753-760. doi: 10.1080/10903127.2020.1819493. Epub 2020 Oct 12.
Ketamine is gaining acceptance as an agent for prehospital pain control, but the associated risks of agitation, hallucinations and sedation have raised concern about its potential to prolong emergency department (ED) length of stay (LOS). This study compared ED LOS among EMS patients who received prehospital ketamine, fentanyl or morphine specifically for pain control. We hypothesized ED LOS would not differ between patients receiving the three medications.
This retrospective observational study utilized the 2018 ESO Research Database, which includes more than 7.5 million EMS events attended by more than 1,200 agencies. Inclusion criteria were a 9-1-1 scene response; age ≥ 18 years; a recorded pain score greater than 4; an initial complaint or use of a treatment protocol indicating a painful condition; prehospital administration of ketamine, fentanyl or morphine; and ED LOS data available. Patients were excluded if they received a combination of the medications, or if there were indications that medication administration could have been for airway management (i.e., altered mental status, head injury, respiratory distress/depression) or agitation control (e.g., behavioral complaints). Kruskal-Wallis test was used to compare ED LOS among patients receiving each of the three medications. evaluations of between-group differences were conducted using Wilcoxon Rank Sum test and a Bonferroni-corrected alpha value of 0.017.
Of 9,548 patients who met the inclusion criteria, 119 received ketamine, 1,359 received morphine, and 8,070 received fentanyl. Patient and event characteristics did not significantly differ between the three groups. Median (IQR) ED LOS was 3.5 (2.5-6.1) hours for patients who received ketamine, 4.0 (2.7-6.1) hours for patients who received morphine, and 3.7 (2.6-5.4) hours for patients who received fentanyl (p = 0.002). In pairwise comparisons, patients who received morphine had significantly longer ED LOS than patients who received fentanyl (p < 0.001); there was no significant difference in ED LOS for patients who received ketamine vs. morphine (p = 0.161) or for patients who received ketamine vs. fentanyl (p = 0.809).
ED LOS is not longer for patients who receive prehospital ketamine, versus morphine or fentanyl, for management of isolated painful non-cardiorespiratory conditions.
氯胺酮作为一种院前疼痛控制药物已被广泛接受，但它引起的激越、幻觉和镇静等相关风险引起了人们对其延长急诊部（ED）停留时间（LOS）的担忧。本研究比较了专门用于疼痛控制的院前给予氯胺酮、芬太尼或吗啡的 EMS 患者的 ED LOS。我们假设接受这三种药物的患者的 ED LOS 没有差异。
这是一项回顾性观察研究，使用了 2018 年 ESO 研究数据库，该数据库包含了超过 1200 家机构参与的超过 750 万例 EMS 事件。纳入标准为：9-1-1 现场反应；年龄≥18 岁；记录的疼痛评分大于 4；最初的投诉或使用治疗方案表明存在疼痛状况；院前给予氯胺酮、芬太尼或吗啡；以及 ED LOS 数据可用。如果患者同时接受了多种药物治疗，或者存在药物治疗可能是为了气道管理（即意识状态改变、头部损伤、呼吸窘迫/抑郁）或激越控制（例如，行为投诉）的迹象，则将患者排除在外。Kruskal-Wallis 检验用于比较接受三种药物治疗的患者之间的 ED LOS。使用 Wilcoxon 秩和检验和校正后的 alpha 值为 0.017 对组间差异进行评估。
在符合纳入标准的 9548 名患者中，119 名接受了氯胺酮，1359 名接受了吗啡，8070 名接受了芬太尼。三组患者的人口统计学和事件特征无显著差异。接受氯胺酮的患者的 ED LOS 中位数（IQR）为 3.5（2.5-6.1）小时，接受吗啡的患者为 4.0（2.7-6.1）小时，接受芬太尼的患者为 3.7（2.6-5.4）小时（p=0.002）。在两两比较中，接受吗啡的患者的 ED LOS 明显长于接受芬太尼的患者（p<0.001）；接受氯胺酮的患者与接受吗啡的患者（p=0.161）或接受氯胺酮的患者与接受芬太尼的患者（p=0.809）之间的 ED LOS 无显著差异。
对于治疗孤立性疼痛非心肺疾病的患者，院前给予氯胺酮与吗啡或芬太尼相比，ED LOS 没有延长。
