title: Prevalence and relief of pain in trauma patients in emergency medical services.
abstract: OBJECTIVE
  The aim of this study was to give insight in the prevalence of pain, and the (effect of) pain management according to the national emergency medical services analgesia protocol in trauma patients in the Netherlands.
  
  
  METHODS
  The retrospective document study included adult and alert trauma patients. Data collection concerned patient characteristics, prevalence of pain, and the (effect of) pain management. Actual pain management was compared with the national emergency medical services analgesia protocol for paramedics. Pain relief was defined as a decrease on the Numeric Rating Scale.
  
  
  RESULTS
  One thousand four hundred and seven trauma patients were included. A report on pain was missing in 28% of the patients (n=393), 2% of the patients (n=34) reported no pain, and the prevalence of pain was reported by 70% of the patients (n=980). Of the patients in pain, 31% (n=311) had a systematic pain assessment (Numeric Rating Scale) at the scene of accident and the median pain score was 6 (interquartile range=3 to 8). Pharmacological pain treatment was administered to 42% of the patients in pain (n=410), and consisted mainly of intravenous fentanyl. Nonpharmacological pain treatments were cleaning of wounds (n=189), and application of splints or immobilizing bandages (n=130). Pain relief on arrival in the emergency department could only be evaluated in 15% of the patients in pain (n=149).
  
  
  CONCLUSIONS
  Prevalence of pain in trauma was high, and without consistent "objective" reporting of pain it is difficult to evaluate the effectiveness of pain management, despite the adherence to clinical practice guideline or protocol. Paramedics need to elicit and report validated pain measurements.
authors.affiliation: Emergency Department and Emergency Healthcare Network, Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. S.Berben@azo.umcn.nl
authors.forename: Sivera A A
authors.initials: SA
authors.lastname: Berben
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.forename: Tineke H J M
authors.initials: TH
authors.lastname: Meijs
authors.forename: Arie B
authors.initials: AB
authors.lastname: van Vugt
authors.forename: Pierre M
authors.initials: PM
authors.lastname: van Grunsven
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000209:etiology*; D059408:Pain Management; D015995:Prevalence; D018709:Statistics, Nonparametric; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult