title: Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline.
abstract: BACKGROUND
  Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was developed. The aim of this study was to assess whether current practice is in compliance with the guideline 'Pain management for trauma patients in the chain of emergency care' from the Netherlands Association for Emergency Nurses (in Dutch NVSHV), and to evaluate early and initial pain management for adult trauma patients in emergency care.
  
  
  METHODS
  Chart reviews were conducted in three regions of the Netherlands using electronic patient files of trauma patients from the chain of emergency care. We included one after-hours General Practitioner Co-operation (GPC), one ambulance Emergency Medical Services (EMS), two Helicopter Emergency Medical Services (HEMS), and three Emergency Departments (EDs). Organisation of pain management, pain assessment, and pain treatment was examined and compared with national guideline recommendations, including quality indicators.
  
  
  RESULTS
  We assessed a random sample of 1066 electronic patient files. The use of standardised tools to assess pain was registered in zero to 52% of the electronic patient files per organisation. Registration of (non-)pharmacological pain treatment was found in less than half of the files. According to the files, pharmacological pain treatment deviated from the guideline in 73-99% of the files. Time of administration of medication was missing in 73-100%. Reassessment of pain following pain medication was recorded in half of the files by the HEMS, but not in files of the other organisations.
  
  
  CONCLUSIONS
  The (registration of) current pain management in trauma patients in the chain of emergency care varies widely between healthcare organisation, and deviates from national guideline recommendations. Although guideline compliance differs across groups of healthcare professionals, maximum compliance rate with indicators registered is 52%. In order to improve pain management and evaluate its effectiveness, we recommend to improve pain registration in patient files. Furthermore, we advise to identify barriers and facilitators related to the implementation of the national guideline in all emergency care organisations.
authors.affiliation: Regional Emergency Healthcare Network, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Scholten
authors.affiliation: Regional Emergency Healthcare Network, Radboud University Medical Centre, Nijmegen, The Netherlands. Electronic address: Sivera.Berben@radboudumc.nl.
authors.forename: S A A
authors.initials: SA
authors.lastname: Berben
authors.affiliation: Regional Emergency Healthcare Network, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Work and Social Psychology, Maastricht University, The Netherlands; Department of Nursing, Amsterdam University of Applied Sciences, The Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: Westmaas
authors.affiliation: Ambulance Emergency Medical Service GelderlandZuid, Nijmegen, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: van Grunsven
authors.affiliation: Cooperative GP Service Nijmegen (CIHN), Nijmegen, The Netherlands.
authors.forename: E T
authors.initials: ET
authors.lastname: de Vaal
authors.affiliation: Department of Emergency Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: P P M
authors.initials: PP
authors.lastname: Rood
authors.affiliation: Department of Anaesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands; HEMS, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Hoogerwerf
authors.affiliation: Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: C J M
authors.initials: CJ
authors.lastname: Doggen
authors.affiliation: Regional Emergency Healthcare Network, Radboud University Medical Centre, Nijmegen, The Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: L
authors.initials: L
authors.lastname: Schoonhoven
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D003299:Cooperative Behavior; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology / Q000628:therapy*
chemical_list: D000700:Analgesics
keywords: Acute pain; Emergency Department; Emergency Medical Services; Emergency care; Guideline; Pain management; Trauma; Wounds and injuries