Bjerén Rasmus, Magnusson Carl, Herlitz Johan, Bäckström Denise
Center for Research and Development, Region Gävleborg, Gävle, Sweden.
Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
Scand J Trauma Resusc Emerg Med. 2025 Jan 27;33(1):12. doi: 10.1186/s13049-025-01328-z.
Acute abdominal pain (AAP) is a common reason for calling emergency medical services (EMS). Despite the widely acknowledged importance of effective prehospital pain management, described by patients as crucial regardless of any other factor, studies on prehospital pain management in AAP patients are limited and suggest room for improvement. This is particularly relevant given the long-standing controversy surrounding the use of analgesia in AAP patients before a final diagnosis is made, which may still influence the prehospital pain management.
A retrospective cohort study of pain management in EMS patients with AAP in a central Swedish region. The region had a population density of 15.7 inhabitants per square kilometer spread over a mix of small urban and rural settings. Patient records were manually reviewed and scanned for written assessments or numeric ratings of pain. The analysis focused on proportions of assessment, treatment and reassessment of pain as well as median pain intensity, pain reduction and proportion of patients with a low last recording of pain.
816 patients were included. Pain was assessed in 55% (n = 447) of all cases. The median initial pain intensity was eight units (IQR 6.0-9.0) on the Numerical Rating Scale (NRS), and 90% (n = 403) of the assessed patients experienced moderate or severe pain. Of those, 62% (n = 249) received pharmacological treatment. In 50% (n = 158) of all cases receiving treatment, pain was reassessed afterwards. The median pain reduction was four units (IQR 2.0-5.0) on the NRS scale. Among all cases, 10% (n = 84) had a last recorded pain assessment indicating low pain.
Significant room for improvement in the prehospital management of acute abdominal pain was found. The proportions of pain assessment, treatment and reassessment were low with nine out of ten patients leaving prehospital care with unknown, moderate or severe pain. Among the cases where pain assessment, treatment and reassessment were made and recorded, four out of five patients experienced significant pain relief, indicating the potential of better prehospital pain management.
急性腹痛（AAP）是呼叫紧急医疗服务（EMS）的常见原因。尽管有效院前疼痛管理的重要性已得到广泛认可，患者认为无论其他任何因素，疼痛管理都至关重要，但关于AAP患者院前疼痛管理的研究有限，且表明仍有改进空间。鉴于在最终诊断前AAP患者使用镇痛剂存在长期争议，这可能仍会影响院前疼痛管理，这一点尤其相关。
对瑞典中部地区患有AAP的EMS患者的疼痛管理进行回顾性队列研究。该地区人口密度为每平方公里15.7人，分布在小型城市和农村混合区域。人工查阅患者记录并扫描，以获取疼痛的书面评估或数字评分。分析重点在于疼痛评估、治疗和重新评估的比例，以及疼痛强度中位数、疼痛减轻程度和最后记录疼痛程度较低的患者比例。
纳入816例患者。所有病例中55%（n = 447）进行了疼痛评估。数字评分量表（NRS）上初始疼痛强度中位数为8分（四分位间距6.0 - 9.0），90%（n = 403）的评估患者经历中度或重度疼痛。其中，62%（n = 249）接受了药物治疗。在所有接受治疗的病例中，50%（n = 158）随后进行了疼痛重新评估。NRS量表上疼痛减轻中位数为4分（四分位间距2.0 - 5.0）。在所有病例中，10%（n = 84）最后记录的疼痛评估表明疼痛程度较低。
发现急性腹痛院前管理有显著改进空间。疼痛评估、治疗和重新评估的比例较低，十分之九的患者在离开院前护理时疼痛情况未知、为中度或重度。在进行并记录了疼痛评估、治疗和重新评估的病例中，五分之四的患者疼痛得到显著缓解，表明更好的院前疼痛管理具有潜力。
