EFFECTIVENESS OF ACUTE PAIN MANAGEMENT ON PAIN REDUCTION IN PATIENTS WITH MUSCULOSKLETAL TRAUMA THROUGHOUT THE CHAIN OF EMERGENCY CARE
Heurman G, Pierik JGJ, Doggen CJM, IJzerman MJ
Universiteit of Twente, Health Technology & Services Research, Faculty Management & Governance, Enschede, Nederland
INTRODUCTION: Pain is the most presented complaint of patients in the Emergency Department (ED). When pain is started recently and is associated with an injury it is considered as acute pain, which is often experienced in patients with musculoskeletal trauma. Effective pain management leads to earlier mobilization and recovery of trauma. Pain relief can be achieved through pharmacological and non-pharmacological pain management provided by physicians and nurses in ED and in prehospital setting, but also patients take initiatives in the field of pain management before attending ED. Studies into pain management have been performed separately within prehospital setting and ED but not yet throughout the chain of emergency care. It is also unknown what initiatives patients take towards pain management in prehospital phase.
This study examined the effectiveness of acute pain management on pain reduction in patients with musculoskeletal trauma throughout the chain of emergency care. Throughout the chain of emergency care patient initiatives towards pain management, pain management by other health professionals in prehospital phase, pain management in ambulance in prehospital phase and pain management in ED were examined.
METHODS: Through a prospective cohort study patients with musculoskeletal trauma that attended the ED of Medical Spectrum Twente (MST) were followed over time from the moment they attended ED till discharge from ED. They were part of the PROTACT Study which is approved by Medical Ethical Committee (METC). Included were patients aged 18 till 69 years with injury through blunt trauma with the ability to read, speak and understand Dutch. Exclusion criteria were patients with a (1) life or limb threatening condition, (2) hallucinations, delusions or homicidal ideation, (3) alcohol or drugs intoxication and (4) patients with multiple trauma. Data was collected through questionnaires, ambulance records, hospital registration system and ED registration system. Patients were asked about pain management initiatives in prehospital phase and in ED and pain scores measured using the NRS at admission in ED and discharge from ED. Primary outcome was the reduction of the mean pain score between admission and discharge from ED. Secondary outcome was the number of patients with a clinically relevant reduction of the pain score.
Statistical analysis is done through descriptive statistics, chi-square test, analysis of variance ANOVA and multivariable linear regression analysis.
RESULTS: A total of 248 patients is used to examine the effectiveness of pain management throughout the chain of emergency care. Largest group were patients with fractures. Prevalence of pain was found to be very high, both on admission and discharge. No differences were found for mean reduction of the pain score between patients that received pain management in prehospital phase and did not receive pain management in prehospital phase. In the effectiveness of pain management in the ED, patients that received pain management in ED reported a higher reduction of the mean pain score. Patients that received pain management reported also a higher pain score at arrival compared to patients that did not receive pain management.
DISCUSSION: Pain management in the prehospital phase makes no difference in the mean reduction of the pain score at discharge from ED compared to patients with no pain management in prehospital phase. In the effectiveness of pain management throughout the chains, all chains where pain management is administered in ED do have a higher reduction of the mean pain score at discharge from ED. The importance of pain management in ED for the reduction of the pain score at discharge from ED is also reflected in the number of patients with a clinical reduction of their pain score at discharge from ED.