Document Detail

Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study.
MedLine Citation:
PMID:  23059961     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Prehospital oligoanalgesia is prevalent among trauma victims, even when the emergency medical services team includes a physician. We investigated if not only patients' characteristics but physicians' practice variations contributed to prehospital oligoanalgesia.
METHODS: Patient records of conscious adult trauma victims transported by our air rescue helicopter service over 10 yr were reviewed retrospectively. Oligoanalgesia was defined as a numeric rating scale (NRS) >3 at hospital admission. Multilevel logistic regression analysis was used to predict oligoanalgesia, accounting first for patient case-mix, and then physician-level clustering. The intraclass correlation was expressed as the median odds ratio (MOR).
RESULTS: A total of 1202 patients and 77 physicians were included in the study. NRS at the scene was 6.9 (1.9). The prevalence of oligoanalgesia was 43%. Physicians had a median of 5.7 yr (inter-quartile range: 4.2-7.5) of post-graduate training and 27% were female. In our multilevel analysis, significant predictors of oligoanalgesia were: no analgesia [odds ratio (OR) 8.8], National Advisory Committee for Aeronautics V on site (OR 4.4), NRS on site (OR 1.5 per additional NRS unit >4), female physician (OR 2.0), and years of post-graduate experience [>4.0 to ≤5.0 (OR 1.3), >3.0 to ≤4.0 (OR 1.6), >2.0 to ≤3.0 (OR 2.6), and ≤2.0 yr (OR 16.7)]. The MOR was 2.6, and was statistically significant.
CONCLUSIONS: Physicians' practice variations contributed to oligoanalgesia, a factor often overlooked in analyses of prehospital pain management. Further exploration of the sources of these variations may provide innovative targets for quality improvement programmes to achieve consistent pain relief for trauma victims.
E Albrecht; P Taffe; B Yersin; P Schoettker; I Decosterd; O Hugli
Publication Detail:
Type:  Journal Article     Date:  2012-10-11
Journal Detail:
Title:  British journal of anaesthesia     Volume:  110     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-13     Completed Date:  2013-02-07     Revised Date:  2014-08-13    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  96-106     Citation Subset:  IM    
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MeSH Terms
Acute Pain / drug therapy*,  epidemiology*,  etiology
Aged, 80 and over
Analgesia / utilization
Analgesics, Opioid / therapeutic use
Emergency Medical Services / methods*
Fentanyl / therapeutic use
Glasgow Coma Scale
Health Services Needs and Demand
Likelihood Functions
Middle Aged
Pain Management
Pain Measurement
ROC Curve
Retrospective Studies
Sex Factors
Trauma Centers
Wounds and Injuries / complications,  therapy*
Young Adult
Reg. No./Substance:
0/Analgesics, Opioid; UF599785JZ/Fentanyl
Comment In:
Br J Anaesth. 2013 May;110(5):848   [PMID:  23599523 ]
Br J Anaesth. 2013 May;110(5):848-9   [PMID:  23599524 ]
Br J Anaesth. 2013 May;110(5):849-50   [PMID:  23599526 ]
Br J Anaesth. 2013 May;110(5):849   [PMID:  23599525 ]
Tidsskr Nor Laegeforen. 2014 May 27;134(10):1022   [PMID:  24865717 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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