Factors associated with unoffered trauma analgesia in critical care transport.
OBJECTIVE
Pain relief is a key out-of-hospital patient care outcome measure, yet many trauma patients do not receive prompt analgesia. Although specialty critical care transport (CCT) teams provide analgesia frequently, successfully, and safely, there is still a population of CCT patients to whom analgesia is not offered. We report the factors associated with non-administration of analgesia and with analgesic effect in trauma patients cared for by CCT teams.


METHODS
This is a retrospective review of consecutive transport records for nonintubated trauma patients with self-reported pain during specialty CCT care. Patient demographics, CCT interventions, clinical traits, and pain self-reports are measured. Means comparisons are made with a univariate analysis of variance, and odds ratios (ORs) with 95% confidence intervals (CIs) are reported for between-group comparisons.


RESULTS
Of the 209 enrolled patients, 169 (80.9%; 95% CI, 75.6%-86.2%) were treated (147 received analgesia and 22 offered analgesia but refused). In patients with pain scale documentation (n=145), self-reported pain on a scale from 0 to 10 decreased from 6.8+/-2.8 to 3.3+/-2.4 (P<or=.001). Three factors were associated with absence of analgesic administration: initial pain level (OR for administration, 0.13; 95% CI, 0.04-0.40), pain scale documentation (OR, 0.31; 95% CI, 0.15-0.60), and transport program (OR, 0.36; 95% CI, 0.17-0.74). No clinical factor was associated with analgesia effectiveness in treated patients.


CONCLUSIONS
The identified factors may represent opportunities for CCT teams to optimize analgesic treatment.
Frakes
Michael A
MA
LIFE STAR/Hartford Hospital, PO Box 5037, Hartford, CT 06102-5037, USA; Boston MedFlight, Bedford, MA 01730, USA.
Lord
Wendy R
WR
LIFE STAR/Hartford Hospital, PO Box 5037, Hartford, CT 06102-5037, USA; Connecticut Children's Medical Center, Hartford, CT 06106, USA.
Kociszewski
Christine
C
Boston MedFlight, Bedford, MA 01730, USA.
Wedel
Suzanne K
SK
Boston MedFlight, Bedford, MA 01730, USA; Boston Medical Center, Boston, MA 02118, USA.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D014187:Transportation of Patients; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult