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Häske D, Dorau W, Eppler F, Heinemann N, Metzger F, Schempf B. Prevalence of prehospital pain and pain assessment difference between patients and paramedics: a prospective cross-sectional observational study. Sci Rep 2024; 14:5613. [PMID: 38453981 PMCID: PMC10920866 DOI: 10.1038/s41598-024-56072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
Adequate analgesia is one of the most important interventions in emergency medicine. However, studies suggest that many patients are undertreated for pain. There can be many reasons why patients assess their pain differently to the paramedics. This study aimed to assess the differences in pain ratings between patients and paramedics and factors influencing them in prehospital emergencies. This prospective cross-sectional observational study included patients treated and transported by paramedics or paramedics and emergency physicians of the German Red Cross in Reutlingen, Germany. This study included 6,365 patients. The prevalence of pain was 49.7%. Among patients with a self-reported numerical rating scale (NRS) > 0, the mean patient pain rating was NRS 4.2 ± 2.7, while the mean paramedic pain rating was NRS 3.6 ± 2.4 (p < 0.001). Approximately 11.8% (n = 751) of patients reported subjectively unbearable pain. Patients reported a mean NRS of 7.7 ± 1.8 for unbearable pain, but a mean NRS of 3.3 ± 2.0 for bearable pain (p < 0.001). The difference in pain ratings between patients and paramedics increased with pain severity. Univariate analysis showed that there were no gender differences, but the difference in pain rating was influenced by patient age (p < 0.001) and paramedic age (p = 0.042). The differences in pain ratings were particularly pronounced for abdominal diseases (p < 0.001) and trauma (p < 0.001). There is a difference in pain ratings between patients and paramedics, which increases with pain severity and appears to be associated with the patient's age and the paramedic's age. To determine the desire and need for analgesics, the question about unbearable pain is a good addition to the NRS.
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Affiliation(s)
- David Häske
- Center for Public Health and Health Services Research, University Hospital Tübingen, Osianderstrasse 5, 72076, Tübingen, Germany.
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany.
| | - Wolfgang Dorau
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
| | - Fabian Eppler
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
| | - Niklas Heinemann
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
| | - Florian Metzger
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
| | - Benjamin Schempf
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
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Ketter V, Ruchholtz S, Frink M. [Trauma center management]. Med Klin Intensivmed Notfmed 2021; 116:400-404. [PMID: 33847765 DOI: 10.1007/s00063-021-00807-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022]
Abstract
Every year, more than 20,000 patients with polytrauma are treated in Germany. The term polytrauma refers to simultaneous injury to several body regions that are individually or collectively life-threatening for the patient. However, this assessment is made based on appropriate scoring systems. Adequate treatment of these patients requires not only medical care at the highest level, but also coordination of organizational/logistical processes. The link between preclinical and clinical care is treatment in the shock room, which should be led by a defined, experienced "trauma leader". Treatment algorithms are based on the current S3 guideline Polytrauma/Serious Injury Treatment of the AWMF and the White Paper on Serious Injury Care. Here, recommendations are defined regarding personnel, spatial, logistical and material requirements. Every shock room team should be trained regularly and have theoretical and practical knowledge on the application of shock room algorithms. This can improve the quality of treatment and thus the probability of survival of critically ill patients. In the shock room itself, the focus is on standardized and priority-oriented assessment and stabilization of the patient. Due to the varying quality of care for severely injured patients in Germany, the TraumaNetwork DGU® initiative was implemented by the German Society of Trauma Surgery to improve the treatment of polytrauma patients by defining standards and improving processes and organization in the care of severely injured patients. In Germany, there are currently 615 participating hospitals that are organized in 52 local trauma networks, some of which are cross state borders.
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Affiliation(s)
- Vanessa Ketter
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Steffen Ruchholtz
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Michael Frink
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
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Abstract
Adequate analgesia is one of the most important measures of emergency care in addition to treatment of vital function disorders and, if indicated, should be promptly undertaken; however, a large proportion of emergency patients receive no or only inadequate pain therapy. The numeric rating scale (NRS) is recommended for pain assessment but is not applicable to every group of patients; therefore, vital signs and body language should be included in the assessment. Pain therapy should reduce the NPRS to <5 points. Ketamine and fentanyl, which have an especially rapid onset of action, and also morphine are suitable for analgesia in spontaneously breathing patients. Basic prerequisites for safe and effective analgesia by healthcare professionals are the use of adequate monitoring, the provision of well-defined emergency equipment, and the mastery of emergency procedures. In a structured competence system, paramedics and nursing personnel can perform safe and effective analgesia.
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Schimrigk J, Baulig C, Buschmann C, Ehlers J, Kleber C, Knippschild S, Leidel BA, Malysch T, Steinhausen E, Dahmen J. [Indications, procedure and outcome of prehospital emergency resuscitative thoracotomy-a systematic literature search]. Unfallchirurg 2020; 123:711-723. [PMID: 32140814 DOI: 10.1007/s00113-020-00777-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prehospital resuscitative thoracotomy (PHRT) is a controversially discussed measure for the acute treatment of traumatic cardiac arrest (TCA) recommended by the current guidelines of the European Resuscitation Council (ERC). The aim of this work is the comprehensive presentation and summary of the available literature with the underlying hypothesis that the available publications show the feasibility and survival following PHRT in patients with TCA with a good neurological outcome. METHOD A systematic literature search was performed in the databases PubMed, EMBASE, Google Scholar, Springer LINK and Cochrane. The study selection, data extraction and evaluation of bias potential were performed independently by two authors. The outcome of patients with TCA after PHRT was selected as the primary endpoint. RESULTS A total of 4616 publications were found of which 21 publications with a total of 287 patients could be included in the analyses. For a detailed descriptive analysis, 15 publications with a total of 205 patients were suitable. The TCA of these patients was most commonly caused by pericardial tamponade, thoracic vascular injuries and severe extrathoracic multiple injuries. In 24% of the cases TCA occurred in the presence of the emergency physician. Clamshell thoracotomy (53%) was used preclinically more often than anterolateral thoracotomy (47%). Of the PHRT patients after TCA 12% (25/205) left the hospital alive, 9% (n = 19/205) with good neurological outcome and 1% (n = 3/205) with poor neurological outcome (according to the Glasgow outcome scale, GOS). CONCLUSION The prognosis of TCA seems to be much better than has long been assumed. Decisive for the success of resuscitation efforts in TCA seems to be the immediate, partly invasive treatment of all reversible causes. The measures for TCA recommended by the ERC resuscitation guidelines, seem to be poorly implemented, especially in the preclinical setting. A controversy regarding the recommendations of the guidelines is the question of whether a PHRT can be successfully implemented and if the comprehensive introduction in Germany seems to be meaningful. Despite the recommendation of the guidelines, this systematic review and meta-analysis underlines the lack of high-quality evidence on PHRT, whereby a survival probability to hospital discharge of 12% was reported, of which 75% had a good neurological outcome. The risk of bias of the results in individual publications as well as in this review is high. Further systematic research in the field of preclinical trauma resuscitation is particularly necessary also for acceptance of the guidelines.
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Affiliation(s)
- J Schimrigk
- Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Baulig
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Buschmann
- Institut für Rechtsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
- AG Trauma, Deutscher Rat für Wiederbelebung - German Resuscitation Council (GRC), Ulm, Deutschland
| | - J Ehlers
- Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Kleber
- AG Trauma, Deutscher Rat für Wiederbelebung - German Resuscitation Council (GRC), Ulm, Deutschland
- Chirurgische Notaufnahme, Universitätszentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum TU Dresden, Dresden, Deutschland
| | - S Knippschild
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - B A Leidel
- Zentrale Notaufnahme, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Malysch
- Klinik für Anästhesiologie und Intensivtherapie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Deutschland
| | - E Steinhausen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland
- Ärztliche Leitung Rettungsdienst Berlin, Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
| | - J Dahmen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland.
- Ärztliche Leitung Rettungsdienst Berlin, Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestraße 2, 10179, Berlin, Deutschland.
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Dahmen J, Brade M, Gerach C, Glombitza M, Schmitz J, Zeitter S, Steinhausen E. [Successful prehospital emergency thoracotomy after blunt thoracic trauma : Case report and lessons learned]. Unfallchirurg 2019; 121:839-849. [PMID: 29872865 DOI: 10.1007/s00113-018-0516-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The European Resuscitation Council guidelines for resuscitation in patients with traumatic cardiac arrest recommend the immediate treatment of all reversible causes, if necessary even prior to continuous chest compression. In the case of cardiac tamponade immediate emergency thoracotomy should also be considered. OBJECTIVE The authors report the case of a 23-year-old male patient with multiple injuries including blunt thoracic trauma, which caused a witnessed cardiac arrest. He successfully underwent prehospital emergency resuscitative thoracotomy. The lessons learned from this case on internal and external quality measures are discussed in detail. RESULTS After 60 min of technical rescue, extensive trauma life support including intubation, chest decompression and bleeding control was carried out. The cardiovascular insufficiency progressively deteriorated and under the suspicion of a cardiac tamponade a prehospital emergency thoracotomy was carried out. After successful resuscitative thoracotomy and return of spontaneous circulation (ROSC) the patient was airlifted to the next level 1 trauma center for damage control surgery (DCS). The patient could be discharged 59 days after the accident and now 2 years later is living a normal life without neurological or cardiopulmonary limitations. Airway management, chest decompression including resuscitative thoracotomy, fluid resuscitation and blood products were the key components to ensure that the patient achieved ROSC. Advanced Trauma Life Support® as well as structural prerequisites made these measures and good results for the patient possible.
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Affiliation(s)
- Janosch Dahmen
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland. .,Luftrettungszentrum CHRISTOPH 9, Großenbaumer Allee 250, 47249, Duisburg, Deutschland. .,Fakultät für Gesundheit, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
| | - Marko Brade
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland.,Luftrettungszentrum CHRISTOPH 9, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Christian Gerach
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Martin Glombitza
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Jan Schmitz
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Simon Zeitter
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Eva Steinhausen
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland.,Fakultät für Gesundheit, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
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Häske D, Böttiger BW, Bouillon B, Fischer M, Gaier G, Gliwitzky B, Helm M, Hilbert-Carius P, Hossfeld B, Schempf B, Wafaisade A, Bernhard M. Analgesie bei Traumapatienten in der Notfallmedizin. Notf Rett Med 2019. [DOI: 10.1007/s10049-019-00629-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Häske D, W. Böttiger B, Bouillon B, Fischer M, Gaier G, Gliwitzky B, Helm M, Hilbert-Carius P, Hossfeld B, Meisner C, Schempf B, Wafaisade A, Bernhard M. Analgesia in Patients with Trauma in Emergency Medicine. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:785-792. [PMID: 29229039 PMCID: PMC5730701 DOI: 10.3238/arztebl.2017.0785] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 11/29/2016] [Accepted: 07/03/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Suitable analgesic drugs and techniques are needed for the acute care of the approximately 18 200-18 400 seriously injured patients in Germany each year. METHODS This systematic review and meta-analysis of analgesia in trauma patients was carried out on the basis of randomized, controlled trials and observational studies. A systematic search of the literature over the 10-year period ending in February 2016 was carried out in the PubMed, Google Scholar, and Springer Link Library databases. Some of the considered trials and studies were included in a meta-analysis. Mean differences (MD) of pain reduction or pain outcome as measured on the Numeric Rating Scale were taken as a summarizing measure of treatment efficacy. RESULTS Out of 685 studies, 41 studies were considered and 10 studies were included in the meta-analysis. Among the drugs and drug combinations studied, none was clearly superior to another with respect to pain relief. Neither fentanyl versus morphine (MD -0.10 with a 95% confidence interval of [-0.58; 0.39], p = 0.70) nor ketamine versus morphine (MD -1.27 [-3.71; 1.16], p = 0.31), or the combination of ketamine and morphine versus morphine alone (MD -1.23 [-2.29; -0.18], p = 0.02) showed clear superiority regarding analgesia. CONCLUSION Ketamine, fentanyl, and morphine are suitable for analgesia in spontaneously breathing trauma patients. Fentanyl and ketamine have a rapid onset of action and a strong analgesic effect. Our quantitative meta-analysis revealed no evidence for the superiority of any of the three substances over the others. Suitable monitoring equipment, and expertise in emergency procedures are prerequisites for safe and effective analgesia by healthcare professionals..
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Affiliation(s)
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne
| | - Bertil Bouillon
- Department of Orthopedics, Trauma Surgery, and Sports Injuries, Cologne Hospitals, University of Witten/Herdecke
| | - Matthias Fischer
- Department of Anesthesiology, Surgical Intensive Care, Emergency Medicine, and Pain Therapy, Hospital am Eichert, ALB FILS Hospitals, Göppingen
| | - Gernot Gaier
- Department of Anesthesiology and Surgical Intensive Care, Hospital am Steinenberg, Reutlingen
| | | | - Matthias Helm
- Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Hospital, Ulm, Germany
| | - Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care, and Emergency Medicine, Bergmannstrost BG Hospital, Halle
| | - Björn Hossfeld
- Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Hospital, Ulm, Germany
| | - Christoph Meisner
- Institute for Clinical Epidemiology and Applied Biometrics, University of Tübingen
| | - Benjamin Schempf
- Department of Medicine II – Cardiology, Angiology, Intensive Care, Hospital am Steinenberg, Reutlingen
| | - Arasch Wafaisade
- Department of Orthopedics, Trauma Surgery, and Sports Injuries, Cologne Hospitals, University of Witten/Herdecke
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Gather A, Beisemann N, Gebhard E, Gliwitzky B, Böttcher M, Geißert S, Swartman B, Kreinest M. Ruhigstellung von Frakturen in der präklinischen Notfallmedizin. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schweigkofler U, Flohé S, Hoffmann R, Matthes G, Paffrath T, Wölfl C, Fischer M, Kehrberger E, Marung H, Moecke H, Prückner S, Urban B, Trentzsch H. [Tracer diagnosis severe injury/polytrauma in key issue paper 2016]. Unfallchirurg 2017; 119:961-963. [PMID: 27757483 DOI: 10.1007/s00113-016-0256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- U Schweigkofler
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt am Main, Deutschland
| | - S Flohé
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städtisches Klinikum Solingen gemeinnützige GmbH, Solingen, Deutschland
| | - R Hoffmann
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt am Main, Deutschland
| | - G Matthes
- Klinik für Unfallchirurgie und Orthopädie, Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - T Paffrath
- Klinik für Unfallchirurgie, Orthopädie & Sporttraumatologie, Lehrstuhl für Unfallchirurgie & Orthopädie, Klinikum der Privaten Universität Witten/Herdecke, Köln, Deutschland
| | - C Wölfl
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Krankenhaus Hetzelstift, Neustadt/Weinstraße, Deutschland
| | - M Fischer
- Arbeitsgemeinschaft Südwestdeutscher Notärzte e. V. (AGSWN), Filderstadt, Deutschland
- Klinik für Anästhesiologie, Operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinik am Eichert, Göppingen, Deutschland
| | - E Kehrberger
- Arbeitsgemeinschaft Südwestdeutscher Notärzte e. V. (AGSWN), Filderstadt, Deutschland
- Klinik für Anästhesiologie und operative Intensivmedizin, Kreiskliniken Esslingen, Paracelsus-Krankenhaus Ruit, Ostfildern, Deutschland
| | - H Marung
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
- Institut für Notfallmedizin (IfN), Asklepios Klinikum Harburg, Hamburg, Deutschland
| | - H Moecke
- Institut für Notfallmedizin (IfN), Asklepios Klinikum Harburg, Hamburg, Deutschland
| | - S Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Ludwig-Maximilians-Universität München, Schillerstraße 53, 80336, München, Deutschland
| | - B Urban
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Ludwig-Maximilians-Universität München, Schillerstraße 53, 80336, München, Deutschland
| | - H Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Ludwig-Maximilians-Universität München, Schillerstraße 53, 80336, München, Deutschland.
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