Muragizi Jean, Guptill Mindi, Dumitriu Bogdan G, Henry Michael B, Aluisio Adam R, Nzabandora Jean Paul, Manirafasha Appolinaire, Baird Janette, Morretti Katelyn, Karim Naz
Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.
Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Afr J Emerg Med. 2023 Sep;13(3):147-151. doi: 10.1016/j.afjem.2023.05.002. Epub 2023 Jun 7.
While trends in analgesia have been identified in high-income countries, little research exists regarding analgesia administration in low- and middle-income countries (LMIC). This study evaluates analgesia administration and clinical characteristics among patients seeking emergency injury care at University Teaching Hospital-Kigali in Kigali, Rwanda.
This retrospective, cross-sectional study utilized a random sample of emergency center (EC) cases accrued between July 2015 and June 2016. Data was extracted from the medical record for patients who had an injury and were ≥ 15 years of age. Injury-related EC visits were identified by presenting complaint or final discharge diagnosis. Sociodemographic information, injury mechanism and type, and analgesic medications ordered and administered were analyzed.
Of the 3,609 random cases, 1,329 met eligibility and were analyzed. The study population was predominantly male (72%) with a median age of 32 years and range between 15 and 81 years. In the studied sample, 728 (54.8%) were treated with analgesia in the EC. In unadjusted logistic regression, only age was not a significant predictor of receiving pain medication and was excluded from the adjusted analysis. In the adjusted model, all predictors remained significant, with being male, having at least one severe injury, and road traffic accident (RTA) as injury mechanism being significant predictors of analgesia administration.
In the study setting of injured patients in Rwanda, being male, involved in RTA or having more than one serious injury was associated with higher odds of receiving pain medication. Approximately half of the patients with traumatic injuries received pain medications, predominantly opioids with no factors predicting whether a patient would receive opioids versus other medications. Further research on implementation of pain guidelines and drug shortages is warranted to improve pain management for injured patients in the LMIC setting.
虽然在高收入国家已确定了镇痛趋势，但关于低收入和中等收入国家（LMIC）镇痛药物使用情况的研究却很少。本研究评估了在卢旺达基加利大学教学医院寻求紧急创伤护理的患者的镇痛药物使用情况和临床特征。
这项回顾性横断面研究采用了2015年7月至2016年6月期间急诊中心（EC）病例的随机样本。从病历中提取了年龄≥15岁的受伤患者的数据。通过就诊主诉或最终出院诊断确定与损伤相关的急诊就诊情况。分析了社会人口统计学信息、损伤机制和类型，以及所开具和使用的镇痛药物。
在3609例随机病例中，1329例符合纳入标准并进行了分析。研究人群以男性为主（72%），年龄中位数为32岁，范围在15至81岁之间。在研究样本中，728例（54.8%）在急诊中心接受了镇痛治疗。在未调整的逻辑回归中，只有年龄不是接受止痛药的显著预测因素，并被排除在调整分析之外。在调整模型中，所有预测因素仍然显著，男性、至少有一处重伤以及道路交通伤（RTA）作为损伤机制是镇痛药物使用的显著预测因素。
在卢旺达受伤患者的研究环境中，男性、涉及道路交通伤或有多处重伤与接受止痛药的几率较高相关。约一半的创伤患者接受了止痛药治疗，主要是阿片类药物，且没有因素可预测患者会接受阿片类药物还是其他药物。有必要进一步研究疼痛指南的实施和药物短缺问题，以改善低收入和中等收入国家环境中受伤患者的疼痛管理。
