1
|
Mota M, Melo F, Henriques C, Matos A, Castelo-Branco M, Monteiro M, Cunha M, Reis Santos M. The relationship between acute pain and other types of suffering in pre-hospital trauma victims: An observational study. Int Emerg Nurs 2023; 71:101375. [PMID: 37913691 DOI: 10.1016/j.ienj.2023.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Acute pain is an important complaint reported by trauma victims, however, the relationship between it and other types of discomfort, such as discomfort caused by cold, discomfort caused by immobilization, and psychological distress such as fear, anxiety, and sadness is limitedly studied and documented. AIM To assess the relationship between acute trauma pain and other types of suffering in pre-hospital trauma victims. METHODS This is a prospective multicentre cohort study conducted in Immediate Life Support Ambulances in Portugal. All adult trauma victims with a mechanism of blunt and penetrating injuries, falls, road accidents and explosions, were included. RESULTS 605 trauma victims were included, mainly male, with a mean age of 53.4 years. Before the intervention of the rescue teams, 90.5 % of the victims reported some level of pain, 39.0 % reported discomfort caused by cold, while 15.7 % felt fear, 8.4 % sadness, 49.8 % anxiety and 4.5 % apathy. Victims with high discomfort caused by cold tend to have higher pain levels. Significantly higher pain intensity were observed in victims with fear and anxiety. Univariate and multivariate analysis indicates that immobilization is associated with increased pain levels. CONCLUSIONS There is a statistically significant relationship between acute trauma pain, anxiety, fear, cold and immobilization.
Collapse
Affiliation(s)
- Mauro Mota
- Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal; Health School of the Polytechnic Institute of Viseu, Portugal; UICISA: E/ESEnfC - Cluster at the Health School of Polytechnic Institute of Viseu, Viseu, Portugal; CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal; Academic Clinical Centre of Beira, Portugal.
| | - Filipe Melo
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Active Ageing Competence Centre, Portugal
| | - Carla Henriques
- Polytechnic Institute of Viseu, Portugal; Centre for Mathematics of the University of Coimbra - CMUC, Portugal; CISeD - Research Centre in Digital Services, Instituto Politécnico de Viseu, Portugal
| | - Ana Matos
- Polytechnic Institute of Viseu, Portugal; Centre for Mathematics of the University of Coimbra - CMUC, Portugal; CISeD - Research Centre in Digital Services, Instituto Politécnico de Viseu, Portugal
| | - Miguel Castelo-Branco
- Academic Clinical Centre of Beira, Portugal; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; UBI-Health Sciencies Reserarch Centre, Portugal; University Hospital Centre of Cova da Beira, Portugal
| | | | - Madalena Cunha
- Health School of the Polytechnic Institute of Viseu, Portugal; UICISA: E/ESEnfC - Cluster at the Health School of Polytechnic Institute of Viseu, Viseu, Portugal; Academic Clinical Centre of Beira, Portugal
| | - Margarida Reis Santos
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal; Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Nursing School of Porto, Porto, Portugal
| |
Collapse
|
2
|
Ayano WA, Fentie AM, Tileku M, Jiru T, Hussen SU. Assessment of adequacy and appropriateness of pain management practice among trauma patients at the Ethiopian Aabet Hospital: A prospective observational study. BMC Emerg Med 2023; 23:92. [PMID: 37592216 PMCID: PMC10433567 DOI: 10.1186/s12873-023-00869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Pain is unpleasant sensory and emotional experiences associated with actual and/or potential tissue damage. It is the most common and prevalent reason for emergency departments (ED) visits with prevalence over 70% in the world. AIM OF THE STUDY The study aimed to assess the adequacy and appropriateness of pain management at Aabet Hospital, Addis Ababa, Ethiopia. METHODS A hospital-based prospective cross-sectional study was conducted at Aabet hospital from December 1, 2020 to March 30, 2021. Adult trauma patients having pain (at least score 1 on Numeric Rating Scale) with Glasgow Coma Scale score > 13 were eligible to participate in the study. The pain intensity was evaluated at the time of admission (o minute) and then at 60, 120, 180, and 240 minutes. The time of the first analgesics was registered. The adequacy and the appropriateness of the pain management were calculated through pain management index (PMI). RESULTS Two hundred thirty-two (232) participants were included in this study of which 126 (54.3%) were admitted due to road traffic accident followed by fall 44(19%). Only 21 (9.1%) study participants received the first analgesic treatment within 30 minutes while 27(11.6%) participants had no treatment at all within 240 minutes. The mean pain intensity score at admission was 5.55 ± 2.32 and reduced to 4.09 ± 2.69. Nearly half 110 (47.4%) of the study participants were treated inadequately (PMI (-) score). There was a weak and negative correlation between PMI and time to analgesia (r = - .159, p = 0.0001). The type of analgesia used, the time to analgesia, and the degree of pain may predict 65% of the variance in PMI score (R2 = 0.65, P = .001). CONCLUSION From the results of this study, it can be concluded that acute pain in trauma patients was under and inappropriately treated.
Collapse
Affiliation(s)
- Wondwossen Alemu Ayano
- Department of Pharmacy, Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melaku Tileku
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tilahun Jiru
- Department of Emergency Medicine and Critical Care, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shemsu Umer Hussen
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Parker R, Bedwell GJ, Hodkinson P, Lourens A, Setshedi M. Managing acute abdominal pain in the emergency centre: Lessons from a patient's experience. Afr J Emerg Med 2021; 11:483-486. [PMID: 34815928 PMCID: PMC8593562 DOI: 10.1016/j.afjem.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/31/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022] Open
Abstract
Pain is one of the most common reasons people present to the emergency centre with 7-10% of presentations being due to acute abdominal pain. However, pain is also often neglected by clinicians in emergency centres. The well validated South African Triage Score (SATS) incorporates pain assessment in the prioritising of patients with the aim of guiding clinicians. Based on the SATS, severe pain (a score of ≥8 out of 10) should prompt the clinician to initiate treatment within 10 min of presentation, as unmanaged pain has multiple negative consequences, including poor outcomes of the acute incident with delayed healing and increased risk of developing chronic pain. In this commentary, we present a patient's experience when attending an emergency centre for acute abdominal pain, describe relevant pain mechanisms and highlight the stages where clinical management could have been optimised.
Collapse
Affiliation(s)
- Romy Parker
- Dept of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Gill J Bedwell
- Dept of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Peter Hodkinson
- Division of Emergency Medicine, Dept of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andrit Lourens
- Division of Emergency Medicine, Dept of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Paramedic Science, School of Nursing, Midwifery and Health, Faculty of Health and Life Sciences Coventry University, Coventry, United Kingdom
| | - Mashiko Setshedi
- Division of Gastroenterology, Dept of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
5
|
van Zyl AGP, Ahmed N, Davids R. The trauma burden on a tertiary surgical intensive care unit during the lockdown period in South Africa: A retrospective observational study. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211019163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Trauma places a significant burden on scarce South African critical care resources. The impact of the lockdown period in 2020 on these resources has not been studied. Restrictions on citizen movement and alcohol sales during the lockdown period presented a unique time period to investigate the burden of trauma on a low–middle-income country tertiary hospital intensive care unit. Methods A retrospective observational analysis of all patients admitted to a tertiary hospital surgical intensive care unit during the lockdown period in 2020, compared to the same time period in 2019 and 2018. Data were analysed to detect if a significant difference was present in the number of trauma admissions, length of stay and mechanisms of trauma. Results A significant decrease in the number of trauma admissions to ICU in 2020 was observed as compared to 2018 and 2019 during the same period ( p = <0.001), with a reduction of nearly 50%. The incidence of trauma admissions was lower in all individual lockdown levels in 2020 as compared to 2018 and 2019, and the lowest incidence was recorded in level 5 of 2020. There was no difference among the length of stay of trauma patients in ICU in 2018, 2019 and 2020. There was no difference between the incidence of trauma admissions during lockdown level 3 (with and without alcohol sales) in 2020 compared to 2018. The profile of penetrating and non-penetrating trauma over the 3 years was the same ( p = 0.22). There were no interactions between years, lockdown periods and penetrating trauma ( p = 0.22). Interpretation There was a significant decrease in the trauma burden presented to the surgical ICU during the lockdown period in 2020. Levels with the strictest restrictions on movement and alcohol use had the greatest measurable impact. The decreased number of trauma patients admitted in 2020 was comparable to the national trend of decreased trauma numbers recorded in all levels of the national healthcare system.
Collapse
Affiliation(s)
- Albert GP van Zyl
- Department of Anaesthesiology and Critical Care, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Nadiya Ahmed
- Department of Critical Care and General Surgery, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Ryan Davids
- Department of Anaesthesiology and Critical Care, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
6
|
Rugg C, Woyke S, Voelckel W, Paal P, Ströhle M. Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis. Scand J Trauma Resusc Emerg Med 2021; 29:28. [PMID: 33526048 PMCID: PMC7852148 DOI: 10.1186/s13049-021-00839-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022] Open
Abstract
Background Sufficient analgesia is an obligation, but oligoanalgesia (NRS> 3) is frequently observed prehospitally. Potent analgesics may cause severe adverse events. Thus, analgesia in the helicopter emergency medical service (HEMS) setting is challenging. Adequacy, efficacy and administration safety of potent analgesics pertaining to injured patients in HEMS were analysed. Methods Observational study evaluating data from 14 year-round physician-staffed helicopter bases in Austria in a 12-year timeframe. Results Overall, 47,985 (34.3%) patients received analgesics, 26,059 of whom were adult patients, injured and not mechanically ventilated on site. Main drugs administered were opioids (n=20,051; 76.9%), esketamine (n=9082; 34.9%), metamizole (n=798; 3.1%) and NSAIDs (n=483; 1.9%). Monotherapy with opioids or esketamine was the most common regimen (n=21,743; 83.4%), while opioids together with esketamine (n= 3591; 13.8%) or metamizole (n=369; 1.4%) were the most common combinations. Females received opioids less frequently than did males (n=6038; 74.5% vs. n=14,013; 78.1%; p< 0.001). Pain relief was often sufficient (> 95%), but females more often had moderate to severe pain on arrival in hospital (n=34; 5.0% vs. n=59; 3.2%; p=0.043). Administration of potent analgesics was safe, as indicated by MEES, SpO2 and respiratory rates. On 10% of all missions, clinical patient assessment was deemed sufficient by HEMS physicians and monitoring was spared. Conclusions Opioids and esketamine alone or in combination were the analgesics of choice in physician-staffed HEMS in Austria. Analgesia was often sufficient, but females more than males suffered from oligoanalgesia on hospital arrival. Administration safety was high, justifying liberal use of potent analgesics in physician-staffed HEMS. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00839-9.
Collapse
Affiliation(s)
- Christopher Rugg
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Simon Woyke
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Wolfgang Voelckel
- Department of Anaesthesiology and Intensive Care Medicine AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Dr.-Franz-Rehrl-Platz 5, 5010, Salzburg, Austria
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Kajetanerplatz 1, 5010, Salzburg, Austria.,Austrian Society for Mountain and High-altitude Medicine (ÖGAHM), Lehnrain 30a, 6414, Mieming, Austria
| | - Mathias Ströhle
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Austrian Society for Mountain and High-altitude Medicine (ÖGAHM), Lehnrain 30a, 6414, Mieming, Austria.
| |
Collapse
|
7
|
Abate H, Mekonnen C. Knowledge, Practice, and Associated Factors of Nurses in Pre-Hospital Emergency Care at a Tertiary Care Teaching Hospital. Open Access Emerg Med 2020; 12:459-469. [PMID: 33408536 PMCID: PMC7781023 DOI: 10.2147/oaem.s290074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pre-hospital emergency care is a medical care given to patients before arrival in the hospital after activation of the emergency team. Poor knowledge and practice about pre-hospital emergency care hurt the health outcomes of the patients. OBJECTIVE This study aimed to assess knowledge and practice nurses at the University of Gondar Compressive Specialized Hospital, Northwest Ethiopia. METHODS An institutional-based cross-sectional study was conducted from March 20 to April 10, 2020. A stratified sampling technique was used to select the study participants. Data were collected using a pretested structured self-administered questionnaire. Data were analyzed using SPSS version 20. To explain study variables, frequency tables and percentages were used. Logistic regression analysis was used to see the association between independent and dependent variables. RESULTS Out of the total 378 respondents, less than half (42.9%) had good knowledge; similarly, 49.5% of them had good practice about pre-hospital emergency care. Male sex and attend formal training were significant associations with both knowledge and practice of pre-hospital emergency nursing care. Male participants (adjusted odds ratio (AOR) = 6.57, 95% confidence interval (CI) (3.79-11.36)) and having training (AOR=1.74, 95% CI (1.83-3.66)) were significantly associated with knowledge of pre-hospital emergency care, whereas male sex (AOR=1.73, 95% CI (1.09-2.73)) and having training (AOR=6.16, 95% CI (2.69-14.10)) were significantly associated with the practice of pre-hospital emergency care. CONCLUSION Knowledge and practice of nurses regarding pre-hospital emergency care was found to be inadequate as compared to previous studies. Male sex and attend formal training showed a positive and significant association with both knowledge and practice of pre-hospital emergency nursing care. The responsible body ought to allow professional development and attending formal training for nurses.
Collapse
Affiliation(s)
- Hailemichael Abate
- Department of Medical Nursing, College of Health Science, Gondar, Ethiopia
| | - Chilot Mekonnen
- Department of Medical Nursing, College of Health Science, Gondar, Ethiopia
| |
Collapse
|