title: The impact of patient sex on paramedic pain management in the prehospital setting.
abstract: OBJECTIVE
  The aim of this study was to establish the impact of patient sex on the provision of analgesia by paramedics for patients reporting pain in the prehospital setting.
  
  
  METHODS
  This retrospective cohort study of paramedic patient care records included all adult patients with a Glasgow Coma Score higher than 12 transported to hospital by ambulance in a major metropolitan area over a 7-day period in 2005. Data collected included demographics, patient report of pain and its type and severity, provision of analgesia by paramedics, and type of analgesia provided. The outcomes of interest were sex differences in the provision of analgesia. Data analysis was by descriptive statistics, chi2 test, and logistic regression.
  
  
  RESULTS
  Of the 3357 patients transported in the study period, 1766 (53%) reported pain; this forms the study sample. Fifty-two percent were female, median age was 61 years, and median initial pain score (on a 0-10 verbal numeric rating scale) was 6. Forty-five percent of patients reporting pain did not receive analgesia (791/1766) (95% confidence interval [CI], 43%-47%), with no significant difference between sexes (P = .93). There were, however, significant sex differences in the type of analgesia administered, with males more likely to receive morphine (17%; 95% CI, 15%-20%) than females (13%; 95% CI, 11%-15%) (P = .01). The difference remains significant when controlled for type of pain, age, and pain severity (odds ratio, 0.61, 95% CI, 0.44-0.84).
  
  
  CONCLUSIONS
  Sex is not associated with the rate of paramedic-initiated analgesia, but is associated with differences in the type of analgesia administered.
authors.affiliation: Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria 3800, Australia. bill.lord@med.monash.edu.au
authors.forename: Bill
authors.initials: B
authors.lastname: Lord
authors.forename: James
authors.initials: J
authors.lastname: Cui
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001315:Australia; D016009:Chi-Square Distribution; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine