Opioid administration in the prehospital setting for patients sustaining traumatic injuries: An evaluation of national emergency medical services data.

Autor: Dalton MK; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, MA, United States; Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ, United States. Electronic address: md1613@njms.rutgers.edu., Semco RS; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, MA, United States. Electronic address: rsemco@bwh.harvard.edu., Ordoobadi AJ; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, MA, United States. Electronic address: aordoobadi@bwh.harvard.edu., Goralnick E; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, MA, United States; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States. Electronic address: egoralnick@bwh.harvard.edu., Chovanes J; Division of Trauma, Department of Surgery, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States; Section of Military, Diplomatic, and Field Affairs, Cooper University Hospital, Camden, NJ, United States. Electronic address: chovanes-john@cooperhealth.edu., Salim A; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, MA, United States. Electronic address: asalim1@bwh.harvard.edu., Jarman MP; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, MA, United States. Electronic address: mjarman@bwh.harvard.edu.
Jazyk: angličtina
Zdroj: Injury [Injury] 2022 Sep; Vol. 53 (9), pp. 2923-2929. Date of Electronic Publication: 2022 Apr 09.
DOI: 10.1016/j.injury.2022.03.068
Abstrakt: Introduction: Despite concerns about long-term dependence, opioids remain the mainstay of treatment for acute pain from traumatic injuries. Additionally, early pain management has been associated with improved long-term outcomes in injured patients. We sought to identify the patterns of prehospital pain management across the United States.
Methods: We used 2019 national emergency medical services (EMS) data to identify the use of pain management for acutely injured patients. Opioid specific dosing was calculated in morphine milligram equivalents (MME). The effects of opioids as well as adverse events were identified through objective patient data and structured provider documentation.
Results: We identified a total of 3,831,768 injured patients, 85% of whom were treated by an advanced life support (ALS) unit. There were 269,281 (7.0%) patients treated with opioids, including a small number of patients intubated by EMS (n = 1537; 0.6%). The median opioid dose was 10 MME [IQR 5-10] and fentanyl was the most commonly used opioid (88.2%). Patients treated with opioids had higher initial pain scores documented by EMS than those not receiving opioids (median: 9 vs 4, p<0.001), and had a median reduction in pain score of 3 points (IQR 1-5) based on the final prehospital pain score. Adverse events associated with opioid administration, including episodes of altered mental status (n = 453; 0.2%) and respiratory compromise (n = 252; 0.1%), were rare. For patients with severe pain (≥8/10), 27.3% of patients with major injuries (ISS ≥15) were treated with opioids, compared with 24.8% of those with moderate injuries (ISS 9-14), and 21.4% of those with minor (ISS 1-8) injuries (p<0.001).
Conclusion: The use of opioids in the prehospital setting significantly reduced pain among injured patients with few adverse events. Despite its efficacy and safety, the majority of patients with major injuries and severe pain do not receive opioid analgesia in the prehospital setting.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Molly P. Jarman, PhD, MPH reports financial support was provided by National Institute on Aging.
(Copyright © 2022 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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