title: An Evidence-based Guideline for prehospital analgesia in trauma.
abstract: BACKGROUND
  The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols.
  
  
  OBJECTIVE
  To develop an evidence-based guideline (EBG) for the clinical management of acute traumatic pain in adults and children by advanced life support (ALS) providers in the prehospital setting. Methods. We recruited a multi-stakeholder panel with expertise in acute pain management, guideline development, health informatics, and emergency medical services (EMS) outcomes research. Representatives of the National Highway Traffic Safety Administration (sponsoring agency) and a major children's research center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide the process of question formulation, evidence retrieval, appraisal/synthesis, and formulation of recommendations. The process also adhered to the National Prehospital Evidence-Based Guideline (EBG) model process approved by the Federal Interagency Council for EMS and the National EMS Advisory Council.
  
  
  RESULTS
  Four strong and three weak recommendations emerged from the process; two of the strong recommendations were linked to high- and moderate-quality evidence, respectively. The panel recommended that all patients be considered candidates for analgesia, regardless of transport interval, and that opioid medications should be considered for patients in moderate to severe pain. The panel also recommended that all patients should be reassessed at frequent intervals using a standardized pain scale and that patients should be re-dosed if pain persists. The panel suggested the use of specific age-appropriate pain scales.
  
  
  CONCLUSIONS
  GRADE methodology was used to develop an evidence-based guideline for prehospital analgesia in trauma. The panel issued four strong recommendations regarding patient assessment and narcotic medication dosing. Future research should define optimal approaches for implementation of the guideline as well as the impact of the protocol on safety and effectiveness metrics.
authors.forename: Marianne
authors.initials: M
authors.lastname: Gausche-Hill
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Brown
authors.forename: Zoë J
authors.initials: ZJ
authors.lastname: Oliver
authors.forename: Comilla
authors.initials: C
authors.lastname: Sasson
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Eschmann
authors.forename: Tasmeen S
authors.initials: TS
authors.lastname: Weik
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Lawner
authors.forename: Ritu
authors.initials: R
authors.lastname: Sahni
authors.forename: Yngve
authors.initials: Y
authors.lastname: Falck-Ytter
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Wright
authors.forename: Knox
authors.initials: K
authors.lastname: Todd
authors.forename: Eddy S
authors.initials: ES
authors.lastname: Lang
mesh_terms: D059787:Acute Pain / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000698:Analgesia / Q000379:methods / Q000592:standards*; D000700:Analgesics / Q000008:administration & dosage / Q000592:standards; D002648:Child; D032921:Consensus; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D055416:Evidence-Based Emergency Medicine / Q000379:methods / Q000592:standards*; D006801:Humans; D059408:Pain Management / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy
chemical_list: D000700:Analgesics