title: Ketamine for prehospital trauma analgesia in a low-resource rural trauma system: a retrospective comparative study of ketamine and opioid analgesia in a ten-year cohort in Iraq.
abstract: BACKGROUND
  Opioid analgesics are used in most trauma systems, and only a few studies report on the use of ketamine for prehospital analgesia. In a low-cost rural trauma system in Iraq paramedics have been using prehospital ketamine analgesia for ten years. This study aims to evaluate the effects of prehospital analgesia on physiologic trauma severity indicators and compare the effect of ketamine and pentazocine on those indicators.
  
  
  METHODS
  The investigation was conducted as a retrospective cohort study with parallel group design. Three subsamples of trauma patients were compared: no analgesia (n = 275), pentazocine analgesia (n = 888), and ketamine analgesia (n = 713). Physiologic severity scores were calculated based on rated values for respiratory rate, blood pressure, and consciousness. The associations between outcomes and explanatory variables were assessed using a generalized linear model.
  
  
  RESULTS
  Paramedic administration of analgesia was associated with a better physiologic severity score (PSS) outcome (p = 0.01). In the two subsamples receiving analgesia significantly better outcomes were observed for respiration (p < 0.0001) and systolic blood pressure (p < 0.0001). In patients with Injury Severity Score >8 ketamine was associated with a significantly better effect on the systolic blood pressure compared to opioid analgesia (p = 0.03).
  
  
  CONCLUSIONS
  Prehospital analgesia for trauma victims improves physiologic severity indicators in a low-resource trauma system. Compared to pentazocine, ketamine was associated with improved blood pressure for patients with serious injuries. In a low-resource setting, ketamine seems to be a good choice for prehospital analgesia in trauma patients.
authors.affiliation: Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, PO Box 6050 Langnes, Tromso, 9037, Norway. losvik@gmail.com.|Tromso Mine Victim Resource Centre, University Hospital of North Norway, PO Box 80, Tromso, 9038, Norway. losvik@gmail.com.
authors.forename: Ole Kristian
authors.initials: OK
authors.lastname: Losvik
authors.affiliation: Trauma Care Foundation Iraq, Sulaymaniyah, Iraq. tcfiraq@yahoo.com.
authors.forename: Mudhafar Kareem
authors.initials: MK
authors.lastname: Murad
authors.affiliation: Norwegian University of Life Sciences, Ås, Norway. eystein.skjerve@nmbu.no.
authors.forename: Eystein
authors.initials: E
authors.lastname: Skjerve
authors.affiliation: Tromso Mine Victim Resource Centre, University Hospital of North Norway, PO Box 80, Tromso, 9038, Norway. husumhans@gmail.com.
authors.forename: Hans
authors.initials: H
authors.lastname: Husum
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007493:Iraq; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D007649:Ketamine