Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study.

TitreUndertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study.
Publication TypeJournal Article
Year of Publication2013
AuthorsAlbrecht, E, Taffé, P, Yersin, B, Schoettker, P, Decosterd, I, Hugli, O
JournalBr J Anaesth
Volume110
Issue1
Pagination96-106
Date Published2013 Jan
DOI10.1093/bja/aes355
ISSN1471-6771
ISBN Number1471-6771 (Electronic)
Mots-clésAcute Pain, Adolescent, Adult, Aged, Aged, 80 and over, Aircraft, Analgesia, Analgesics, Opioid, Emergency Medical Services, Female, Fentanyl, Glasgow Coma Scale, Health Services Needs and Demand, Humans, Likelihood Functions, Male, Middle Aged, Pain Management, Pain Measurement, Retrospective Studies, ROC Curve, Sex Factors, Trauma Centers, Wounds and Injuries, Young Adult
Abstract

BACKGROUND: Prehospital oligoanalgesia is prevalent among trauma victims, even when the emergency medical services team includes a physician. We investigated if not only patients' characteristics but physicians' practice variations contributed to prehospital oligoanalgesia.

METHODS: Patient records of conscious adult trauma victims transported by our air rescue helicopter service over 10 yr were reviewed retrospectively. Oligoanalgesia was defined as a numeric rating scale (NRS) >3 at hospital admission. Multilevel logistic regression analysis was used to predict oligoanalgesia, accounting first for patient case-mix, and then physician-level clustering. The intraclass correlation was expressed as the median odds ratio (MOR).

RESULTS: A total of 1202 patients and 77 physicians were included in the study. NRS at the scene was 6.9 (1.9). The prevalence of oligoanalgesia was 43%. Physicians had a median of 5.7 yr (inter-quartile range: 4.2-7.5) of post-graduate training and 27% were female. In our multilevel analysis, significant predictors of oligoanalgesia were: no analgesia [odds ratio (OR) 8.8], National Advisory Committee for Aeronautics V on site (OR 4.4), NRS on site (OR 1.5 per additional NRS unit >4), female physician (OR 2.0), and years of post-graduate experience [>4.0 to ≤5.0 (OR 1.3), >3.0 to ≤4.0 (OR 1.6), >2.0 to ≤3.0 (OR 2.6), and ≤2.0 yr (OR 16.7)]. The MOR was 2.6, and was statistically significant.

CONCLUSIONS: Physicians' practice variations contributed to oligoanalgesia, a factor often overlooked in analyses of prehospital pain management. Further exploration of the sources of these variations may provide innovative targets for quality improvement programmes to achieve consistent pain relief for trauma victims.

Notes

Publication types: Journal ArticlePublication Status: ppublish

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/23059961?dopt=Abstract

Alternate JournalBr J Anaesth
Citation Key / SERVAL ID3326
PubMed ID23059961

                         

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