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Wennberg P, Pakpour A, Broström A, Karlsson K, Magnusson C. Alfentanil for Pain Relief in a Swedish Emergency Medical Service - An Eleven-Year Follow-up on Safety and Effect. PREHOSP EMERG CARE 2024:1-6. [PMID: 38830199 DOI: 10.1080/10903127.2024.2363509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/25/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Pain is a common symptom in prehospital emergency care and pain treatment in this context can be challenging. While previous research has assessed the use of morphine and other synthetic opioids for pain management in this setting, the evaluation of alfentanil is limited. The objective of this study was to evaluate the safety and effect of intravenous alfentanil when administered by ambulance nurses in prehospital emergency care. METHODS This retrospective observational study consecutively included patients suffering from pain, treated with alfentanil in a Swedish EMS service from September 2011 to 31 September 2022. Data regarding occurrence of adverse events (AE), serious adverse events (SAE) - were used for safety evaluation and pain scores with a visual analogue scale (VAS) before and after treatment were used for evaluation of pain treatment. These data were extracted from the electronic patients' medical records database for analysis. Univariate logistic regression analysis was used to identify significant predictors of AE following injection of alfentanil by nurses in prehospital emergency care. RESULTS During the evaluation period 17,796 patients received pain relief with alfentanil. Adverse events affected 2.5% of the patients, while serious adverse events were identified in 25 cases (0.01%). Out of the 5970 patients with a complete VAS score for pain, the median VAS score was 8 (IQR 3) before treatment and 4 (IQR 3) after treatment. The mean reduction in pain measured by VAS was -4.1 ± 2.6 from the time before, to the evaluation after alfentanil administration. The administration frequency increased during the first year up to a steady level during the later part of the evaluation period. CONCLUSIONS This study proposes that alfentanil represents a safe and efficacious alternative for addressing urgent pain relief within the prehospital emergency context. Alfentanil demonstrates efficacy in alleviating pain across various conditions, with a relatively low risk of adverse events or serious adverse events when administered cautiously.
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Affiliation(s)
- Pär Wennberg
- School of Health Sciences, Jönköping University, Jönköping, Sweden
- Ambulance Services, Skaraborg Hospital, Skövde, Sweden
| | - Amir Pakpour
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Anders Broström
- School of Health Sciences, Jönköping University, Jönköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Vestlandet, Norway
| | - Kåre Karlsson
- Ambulance Services, Skaraborg Hospital, Skövde, Sweden
| | - Carl Magnusson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Romero-Sánchez JM, Sánchez-Almagro CP, White-Ríos M, Paloma-Castro O. Prevalence and clustering of NANDA-I nursing diagnoses in the pre-hospital emergency care setting: A retrospective records review study. J Clin Nurs 2024. [PMID: 38235516 DOI: 10.1111/jocn.16996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/21/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
AIM To determine the prevalence and clustering of NANDA-International nursing diagnoses in patients assisted by pre-hospital emergency teams. DESIGN Retrospective descriptive study of electronic record review. METHODS Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two-step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. RESULTS Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six-cluster solution (n = 26.788) was found. Five clusters had a single high-prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co-occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). CONCLUSION Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre-hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre-hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre-hospital clinical setting. IMPACT What problem did the study address? There are different models of pre-hospital emergency care services. The use of standardized nursing languages in the pre-hospital setting is not homogeneous. Studies on NANDA-I nursing diagnoses in the pre-hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA-I nursing diagnoses in the pre-hospital care setting. Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance. Patients attended by pre-hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre-hospital setting, increasing the evidence of individualized and standardized care plans for pre-hospital care. REPORTING METHOD STROBE checklist has been used as a reporting method. NO PATIENT OR PUBLIC CONTRIBUTION Only patients' records were reviewed without further involvement.
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Affiliation(s)
- José Manuel Romero-Sánchez
- Nursing and Physiotherapy Department, Faculty of Nursing and Physiotherapy, Universidad de Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
| | - César Pedro Sánchez-Almagro
- Medical Emergency Center 061 (CES 061), Andalusian Health Service, Provincial Service 061 in Cádiz, Regional Government of Andalusia, Cádiz, Spain
| | - Melanie White-Ríos
- Hospital Punta de Europa, Andalusian Health Service, Algeciras, Cádiz, Spain
| | - Olga Paloma-Castro
- Nursing and Physiotherapy Department, Faculty of Nursing and Physiotherapy, Universidad de Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
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Alotaibi A, Alghamdi A, Martin GP, Carlton E, Cooper JG, Cook E, Siriwardena AN, Phillips J, Thompson A, Bell S, Kirby KL, Rosser A, Pennington E, Body R. External validation of the Manchester Acute Coronary Syndromes ECG risk model within a pre-hospital setting. Emerg Med J 2023; 40:431-436. [PMID: 37068929 DOI: 10.1136/emermed-2022-212872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/29/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES The Manchester Acute Coronary Syndromes ECG (MACS-ECG) prediction model calculates a score based on objective ECG measurements to give the probability of a non-ST elevation myocardial infarction (NSTEMI). The model showed good performance in the emergency department (ED), but its accuracy in the pre-hospital setting is unknown. We aimed to externally validate MACS-ECG in the pre-hospital environment. METHODS We undertook a secondary analysis from the Pre-hospital Evaluation of Sensitive Troponin (PRESTO) study, a multi-centre prospective study to validate decision aids in the pre-hospital setting (26 February 2019 to 23 March 2020). Patients with chest pain where the treating paramedic suspected acute coronary syndrome were included. Paramedics collected demographic and historical data and interpreted ECGs contemporaneously (as 'normal' or 'abnormal'). After completing recruitment, we analysed ECGs to calculate the MACS-ECG score, using both a pre-defined threshold and a novel threshold that optimises sensitivity to differentiate AMI from non-AMI. This was compared with subjective ECG interpretation by paramedics. The diagnosis of AMI was adjudicated by two investigators based on serial troponin testing in hospital. RESULTS Of 691 participants, 87 had type 1 AMI and 687 had complete data for paramedic ECG interpretation. The MACS-ECG model had a C-index of 0.68 (95% CI: 0.61 to 0.75). At the pre-determined cut-off, MACS-ECG had 2.3% (95% CI: 0.3% to 8.1%) sensitivity, 99.5% (95% CI: 98.6% to 99.9%) specificity, 40.0% (95% CI: 10.2% to 79.3%) positive predictive value (PPV) and 87.6% (87.3% to 88.0%) negative predictive value (NPV). At the optimal threshold for sensitivity, MACS-ECG had 50.6% sensitivity (39.6% to 61.5%), 83.1% specificity (79.9% to 86.0%), 30.1% PPV (24.7% to 36.2%) and 92.1% NPV (90.4% to 93.5%). In comparison, paramedics had a sensitivity of 71.3% (95% CI: 60.8% to 80.5%) with 53.8% (95% CI: 53.8% to 61.8%) specificity, 19.7% (17.2% to 22.45%) PPV and 93.3% (90.8% to 95.1%) NPV. CONCLUSION Neither MACS-ECG nor paramedic ECG interpretation had a sufficiently high PPV or NPV to 'rule in' or 'rule out' NSTEMI alone.
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Affiliation(s)
- Ahmed Alotaibi
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrhman Alghamdi
- College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
| | - Edward Carlton
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
- School of Health and Social Care, University of the West of England Bristol, Bristol, UK
| | - Jamie G Cooper
- Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Eloïse Cook
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - John Phillips
- The Ticker Club (A Cardiac Patient Support Group), Wythenshawe Hospital, Manchester, UK
| | | | - Steve Bell
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Kim Lucy Kirby
- Centre for Health and Clinical Research, School of Health and Social Wellbeing, University of the West of England - St Matthias Campus, Bristol, UK
| | - Andy Rosser
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | | | - Richard Body
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
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Ferri P, Gambaretto C, Alberti S, Parogni P, Rovesti S, Di Lorenzo R, Sollami A, Bargellini A. Pain Management in a Prehospital Emergency Setting: A Retrospective Observational Study. J Pain Res 2022; 15:3433-3445. [PMID: 36324866 PMCID: PMC9621014 DOI: 10.2147/jpr.s376586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Acute pain is a prevalent symptomatology in prehospital emergency care. Although inadequate assessment and treatment of acute pain are associated with various complications, about 43% of adults suffering from pain are undertreated. This phenomenon is poorly studied, and limited data are available in the literature. The objective was to investigate the pain management in a prehospital emergency health-care setting, verifying pain assessment, pharmacological treatment adherence and the effectiveness of pain relief therapy. Patients and Methods A retrospective observational study was conducted in a sample including all adults treated by the professionals of nurse-staffed ambulances and medical cars in an Italian Emergency Medical Services (EMS) from 1 January 2019 to 31 May 2019. We collected both demographic information and Numeric Rating Scale scores, which evaluated presence and intensity of pain, from the EMS paper forms. All analyses were performed using SPSS, version 27. Results The study sample was composed of 629 people: 310 males (49%) and 319 females (51%), with an average age of 64.2±22 years (range 18-108). Pain information was collected in 75.5% (n = 475) of our sample; among them 222 patients (46.7%) suffered from pain. We recorded that 79.7% (n = 177) of the subjects with pain received no pharmacological treatment, and in almost all of the treated cases they did not adhere to the analgesia algorithm in use. Among those who were pharmacologically treated, pain statistically significantly decreased in intensity, from before to after, in both emergency vehicles (nurse-staffed ambulances pre m = 8.36±0.9 vs post m = 4.18±2.2, p<0.001; medical cars pre m = 7.25±1.7 vs post m = 3.50±2.6, p<0.001). Subsequently, pain was only re-ascertained in 24.3% of subjects. Conclusion Our findings confirm that pain is a prevalent symptom in prehospital patients, especially in the younger age range, but that it remains an underrecognized, underestimated, and undertreated symptom with the risk of causing worse health outcomes.
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Affiliation(s)
- Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Sara Alberti
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy,Correspondence: Sara Alberti, Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, 41125, Italy, Tel +390592055599, Email
| | | | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rosaria Di Lorenzo
- Department of Mental Health and Drug Abuse, AUSL of Modena, Modena, Italy
| | - Alfonso Sollami
- Health Professions Service, University Hospital of Parma, Parma, Italy
| | - Annalisa Bargellini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Leszczyński PK, Kalinowska J, Mitura K, Sholokhova D. Injuries to Users of Single-Track Vehicles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12112. [PMID: 36231413 PMCID: PMC9566008 DOI: 10.3390/ijerph191912112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Single-track vehicles (including, among others, scooters, bicycles, mopeds, and motorcycles) are becoming increasingly popular means of transport, especially in large cities. A significant disadvantage of single-track vehicles is the low level of protection of users' bodies during road accidents, which causes life-threatening injuries. The aim of this study is to characterize the injuries of users of single-track vehicles. MATERIAL AND METHODS An analysis of medical documentation of the ambulance service in the region of central Poland covered cases in 2019-2020. Out of 17,446 interventions, a group of 248 road incidents involving single-track vehicles was selected. The data included the scene of the event, the sociodemographic data of the casualties, the injuries suffered, and the clinical diagnoses. Analyses of the correlation of variables with the chi-squared and Spearman's Rho tests were applied. All results were considered significant at p < 0.05. RESULTS In the analyzed period, trips of men accounted for 83.5% of all of the interventions (n = 207), while trips of women accounted for 16.5% (n = 41). The mean age of the victims was 45.66 years (SD ± 20.45). Taking into account the division of single-track vehicles, individual cases were recorded with the participation of bicycles (n = 183), motorcycles (n = 61), and scooters (n = 4). Taking into account the type of event, the following were distinguished: deductions (n = 62), falls (n = 179), and sickness (n = 7). The most common injuries were to the heads of cyclists (n = 101, which constitutes 55.19% of all injuries), lower limb injuries in motorcyclists (n = 35; 57.38%), and head injuries in scooter users (n = 3; 75%). The locations of sustained injuries significantly correlated with the type of vehicle in the cases of head injuries (p = 0.046), spine/back injuries (p = 0.001), pelvis injuries (p = 0.021), and lower limb injuries (p = 0.001). CONCLUSIONS The users of single-track vehicles injured in road accidents were more often men than women. The characteristics of the injuries depended on the type of vehicle. The lack of adequate body protection significantly increases the likelihood of death or damage to health. It is advisable to promote safety rules among users of single-track vehicles, with a particular emphasis on the protection of individual parts of the body.
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Affiliation(s)
- Piotr Konrad Leszczyński
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, ul. Bolesława Prusa 14, 08-110 Siedlce, Poland
| | - Justyna Kalinowska
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, ul. Bolesława Prusa 14, 08-110 Siedlce, Poland
| | - Krzysztof Mitura
- Emergency Medical Service, ul. Dr Jana Huberta 37, 05-300 Mińsk Mazowiecki, Poland
| | - Daryna Sholokhova
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, ul. Bolesława Prusa 14, 08-110 Siedlce, Poland
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