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

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State: Public
Version: author
Serval ID
serval:BIB_4B323A627C9F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study.
Journal
British Journal of Anaesthesia
Author(s)
Albrecht E., Taffe P., Yersin B., Schoettker P., Decosterd I., Hugli O.
ISSN
1471-6771 (Electronic)
ISSN-L
0007-0912
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
110
Number
1
Pages
96-106
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
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.
Keywords
Acute Pain/drug therapy, Acute Pain/epidemiology, Adolescent, Adult, Aged, Aged, 80 and over, Aircraft, Analgesia/utilization, Analgesics, Opioid/therapeutic use, Emergency Medical Services/methods, Female, Fentanyl/therapeutic use, Glasgow Coma Scale, Health Services Needs and Demand, Humans, Likelihood Functions, Male, Middle Aged, Pain Management, Pain Measurement, ROC Curve, Retrospective Studies, Sex Factors, Trauma Centers, Wounds and Injuries/complications, Wounds and Injuries/therapy, Young Adult
Pubmed
Web of science
Create date
09/11/2012 16:04
Last modification date
20/08/2019 14:59
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