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International Journal of Emergency Medicine

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Open Access 01-12-2020 | Analgesics in Dentistry | Original Research

Prehospital acute traumatic pain assessment and management practices in the Western Cape, South Africa: a retrospective review

Authors: Andrit Lourens, Romy Parker, Peter Hodkinson

Published in: International Journal of Emergency Medicine | Issue 1/2020

Abstract

Background

Trauma is a common aetiology of acute pain in the emergency setting, and traumatic injuries have been recognised as a global public health crisis leading to numerous deaths and disabilities. This study aimed to identify the prevalence of acute pain among high acuity trauma patients presenting to a public sector emergency medical service and to describe prehospital acute traumatic pain assessment and management practices amongst emergency care providers in the Western Cape Province, South Africa.

Methods

A retrospective review of electronic patient care reports of trauma patients treated by the South African Western Cape Emergency Medical Services between January 1 and December 31, 2017 was conducted. Stratified random sampling was utilised to select 2401 trauma patients out of 24,575 that met the inclusion criteria.

Results

Of the 2401 patients reviewed, 435 (18.1%) had a pain score recorded, of which 423 (97.2%) were experiencing pain. An additional 8.1% (n = 194) of patients had pain or tenderness mentioned in the working diagnosis but no pain score noted. Eighty-one (18.6%) patients experienced mild pain, 175 (40.2%) moderate pain and 167 (38.2%) severe pain. No association was found between a pain score recorded and age group (≤ 14 versus > 14 years) (p = 0.649) or gender (p = 0.139). Only 7.6% of patients with moderate-to-severe pain and 2.8% of all trauma patients received any form of analgesic medication. No association was found between the administration of analgesia and age group (≤ 14 versus > 14 years) (p = 0.151) or gender (p = 0.054). Patients were more likely to receive analgesia if they had a pain score recorded (p < 0.001), were managed by advanced life support practitioners (p < 0.001) or had severe pain (p = 0.001).

Conclusion

Acute trauma pain assessment and management practices in this prehospital cohort are less well established than reported elsewhere and whether this reflects emergency care training, institutional culture, scopes of practice or analgesic resources, requires further research. Emergency medical services need to monitor and promote quality pain care, enhance pain education and ensure that all levels of emergency care providers have access to analgesic medication approved for prehospital use. Clear and rational guidelines would enable better pain management by all cadres of providers, for all levels of pain.

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IM Diclofenac was likely administered by a doctor on scene prior to transportation to hospital by ambulance.

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Title: Prehospital acute traumatic pain assessment and management practices in the Western Cape, South Africa: a retrospective review
Authors: Andrit Lourens
Romy Parker
Peter Hodkinson
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keyword: Analgesics in Dentistry
Published in: International Journal of Emergency Medicine / Issue 1/2020
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/s12245-020-00278-w

At a glance: The STEP trials

Springer Medicine

Prehospital acute traumatic pain assessment and management practices in the Western Cape, South Africa: a retrospective review

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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