Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

Siriwardena, Aloysius Niroshan; Asghar, Zahid; Lord, Bill; Pocock, Helen; Phung, Viet-Hai; Williams, Julia; Snooks, Helen

doi:10.1016/j.ajem.2018.05.041

Cited by 15 publications

(34 citation statements)

References 25 publications

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“…33,34 In the prehospital setting, data are even scarcer and also reveal inconsistent findings regarding pain management approaches and proper pain relief according to provider gender. 13,[35][36][37] There are several explanations for the discrepancy of findings in literature and discordance with this study. First, most studies in this field were performed in an experimental or hospital/clinic environment.…”

Section: Discussioncontrasting

confidence: 95%

The Influence of Gender Bias: Is Pain Management in the Field Affected by Health Care Provider’s Gender?

Karas

Fridrich

Radomislensky

et al. 2022

Prehosp. Disaster med.

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Introduction: Appropriate pain management indicates the quality of casualty care in trauma. Gender bias in pain management focused so far on the patient. Studies regarding provider gender are scarce and have conflicting results, especially in the military and prehospital settings. Study Objective: The purpose of this study is to investigate the effect of health care providers’ gender on pain management approaches among prehospital trauma casualties treated by the Israel Defense Forces (IDF) medical teams. Methods: This retrospective cohort study included all trauma casualties treated by IDF senior providers from 2015-2020. Casualties with a pain score of zero, age under 18 years, or treated with endotracheal intubation were excluded. Groups were divided according to the senior provider’s gender: only females, males, or both female and male. A multivariate analysis was performed to assess the odds ratio of receiving an analgesic, depending on the presence of a female senior provider, adjusting for potential confounders. A subgroup analysis was performed for “delta-pain,” defined as the difference in pain score during treatment. Results: A total of 976 casualties were included, of whom 835 (85.6%) were male. Mean pain scores (SD) for the female only, male only, and both genders providers were 6.4 (SD = 2.9), 6.4 (SD = 3.0), and 6.9 (SD = 2.8), respectively (P = .257). There was no significant difference between females, males, or both female and male groups in analgesic treatment, overall and per specific agent. This remained true also in the multivariate model. Delta-pain difference between groups was also not significant. Less than two-thirds of casualties in this study were treated for pain among all study groups. Conclusion: This study found no association between IDF Medical Corps providers’ gender and pain management in prehospital trauma patients. Further studies regarding disparities in acute pain treatment are advised.

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Section: Discussioncontrasting

confidence: 95%

The Influence of Gender Bias: Is Pain Management in the Field Affected by Health Care Provider’s Gender?

Karas

Fridrich

Radomislensky

et al. 2022

Prehosp. Disaster med.

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“…Despite the availability of evidence-based guidelines, pain has been shown to be under assessed and undertreated. (14)(15)(16)(17)(18)(19) Several predictors of disparity in the provision of analgesia by paramedics have been described, including sex and age. (20,21) However, there is scant evidence of the effect of paramedic qualification level on analgesic administration in a setting where paramedics at all levels of qualification can provide pharmacological management of pain.…”

Section: Discussionmentioning

confidence: 99%

“…This study found that the majority of patients reporting moderate to severe pain received analgesia, and this is in contrast with other studies that show frequency of analgesia administration by paramedics. (16,19,22) This may reflect the importance placed on the assessment and early management of pain by the ambulance service and/or the clinical capabilities of paramedics employed by this agency. The effect of organizational or cultural influences on pain management may be a useful line on inquiry.…”

Section: Discussionmentioning

confidence: 99%

The influence of paramedic qualification level on the administration of analgesia in the prehospital setting

Lord

Keene²,

Luck

2019

Irish J Para

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BackgroundUndertreatment of pain has been reported in the paramedic literature, and reasons for these disparities are not well understood.AimsAs the qualification level of the paramedic may affect analgesia administration, the primary aim of this study was to determine the impact of paramedic qualification on the provision of any analgesia for patients reporting pain.MethodsRetrospective study of de-identified patient care records from one Australian ambulance service over a period of 6 months. Inclusion criteria were age was > 17 years, initial pain severity score was > 3/10 and Glasgow Coma Score >13. Data were descriptively analysed for analgesia administration and type of analgesic by predictor variables: age, sex, pain score and case nature. Pearson’s chi-square test was used to test for associations between the outcome of interest and predictor variables. Adjusted logged odds of patients receiving analgesia was tested with binomial logistic regression.Findings3173 patient records met the inclusion criteria. ICP treated 86% of the sample population. Of those treated by an AP, 76.2% (n=340) received analgesia, whereas 71.6% (n=1952) of patients treated by an ICP received analgesia (p=0.042). Methoxyflurane was the most frequently administered analgesic, with 39.9% of the patients (n=1,264) receiving this agent; 31.1% of patients (n=988) received morphine, and 14.2% (n=452) received fentanyl. The unadjusted regression model found that AP have higher odds of administering analgesia than ICP paramedics (OR 1.264, p <0.05). However, once other covariates are included in the logistic regression, the significance no longer exists.ConclusionParamedic qualification is not associated with the administration of analgesia in this setting. This study contributes to the gap in knowledge regarding disparities in analgesia for adults experiencing pain and may inform future research that aims to identify and reduce barriers to appropriate pain management in the paramedic practice setting.

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“…Morphine, for example, requires intravenous cannulation and a paramedic to administer; potential side effects may restrict its use (sedation, respiratory depression, nausea, and hypotension). Solutions may include expanding the range of analgesics available, including to non-paramedic staff [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study

et al. 2022

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Background We aimed to investigate clinical benefits and economic costs of inhaled methoxyflurane when used by ambulance staff for prehospital emergency patients with trauma. Comparison is to usual analgesic practice (UAP) in the UK in which patient records were selected if treatment had been with Entonox® or intravenous morphine or intravenous paracetamol. Methods Over a 12-month evaluation period, verbal numerical pain scores (VNPS) were gathered from adults with moderate to severe trauma pain attended by ambulance staff trained in administering and supplied with methoxyflurane. Control VNPS were obtained from ambulance database records of UAP in similar patients for the same period. Statistical modelling enabled comparisons of methoxyflurane to UAP, where we employed an Ordered Probit panel regression model for pain, linked by observational rules to VNPS. Results Overall, 96 trained paramedics and technicians from the East Midlands Ambulance Service NHS Trust (EMAS) prepared 510 doses of methoxyflurane for administration to a total of 483 patients. Comparison data extracted from the EMAS database of UAP episodes involved: 753 patients using Entonox®, 802 patients using intravenous morphine, and 278 patients using intravenous paracetamol. Modelling results included demonstration of faster pain relief with inhaled methoxyflurane (all p-values < 0.001). Methoxyflurane’s time to achieve maximum pain relief was estimated to be significantly shorter: 26.4 min (95%CI 25.0–27.8) versus Entonox® 44.4 min (95%CI 39.5–49.3); 26.5 min (95%CI 25.0–27.9) versus intravenous morphine 41.8 min (95%CI 38.9–44.7); 26.5 min (95%CI 25.1–28.0) versus intravenous paracetamol 40.8 (95%CI 34.7–46.9). Scenario analyses showed that durations spent in severe pain were significantly less for methoxyflurane. Costing scenarios showed the added benefits of methoxyflurane were achieved at higher cost, eg versus Entonox® the additional cost per treated patient was estimated to be £12.30. Conclusion When administered to adults with moderate or severe pain due to trauma inhaled methoxyflurane reduced pain more rapidly and to a greater extent than Entonox® and parenteral analgesics. Inclusion of inhaled methoxyflurane to the suite of prehospital analgesics provides a clinically useful addition, but one that is costlier per treated patient.

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Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

Abstract: There was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction.

Cited by 15 publications

References 25 publications

The Influence of Gender Bias: Is Pain Management in the Field Affected by Health Care Provider’s Gender?

The Influence of Gender Bias: Is Pain Management in the Field Affected by Health Care Provider’s Gender?

The influence of paramedic qualification level on the administration of analgesia in the prehospital setting

Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study

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