Abstract

Background. Traumatic injuries are a major cause of moderate and severe pain in a prehospital setting Pain evaluation at the site of injury is necessary for selecting correct treatment for patients.
Objective. The aim of this study was to evaluate the prehospital use of analgesics among adult traumatically injured patients treated within the Tartu Ambulance Foundation through analysing how the ambulance personnel assesses and treats pain. Another aim was to map the prehospital factors influencing the assessment and treatment processes.
Methods. A retrospective, single-centre service evaluation study with a primary selection of 7,526 electronic patient records (EPR) (adult, 18 years or older; for the period of 01.01.2018 31.12.2018) with the main diagnosis of S00-T98 (ICD-10) was conducted and a polyvariant logistic regression model was created to map the factors that influence pain management.
Results. Out of all the patients participating in this study, 529 (40.3%) received at least one analgesic drug. The odds for receiving analgesics were 2.3 (95% CI 1.68-3.08; p < 0.001) times smaller
when the patients had consumed alcohol compared to patients who were sober before the arrival of the ambulance. Pain assessment before analgesic administration was documented in 15.9% of EPRs. Nurses assessed pain 3.3 times (95% CI 2.0-5.3; p<0.001) more likely compared to physicians. Brief assignment (0-10 min) and hospitalisation reduced the odds of using analgesics 3.6 times (95% CI 1.9-6.8; p<0,001) and 1.59 times (95% CI 1.13-2.24; p<0.007), respectively; longer assignments (>50 min) increased the odds by 3.4 times (95% CI 1.9-6.5; p<0.001).
Conclusions. The current study showed that alcohol consumption among patients, short assignment times, and hospitalization decreased the odds for pharmacological pain management. Longer assignment times, on the contrary, were associated with increased odds. Although nurses as team leaders are more likely to assess pain, the overall prevalence of pain assessment remains low.