Haiglaeelne valuvaigistite kasutamine traumadiagnoosiga patsientidel

Taust ja eesmärgid. Kiirabi käsitletud patsientidel on äge valu sage probleem. Esmane hinnang valule võimaldab patsiendile valida sobivaima ravi. Uuringu eesmärk oli hinnata haiglaeelset valuvaigistite kasutamist Tartu Kiirabi käsitletud traumadiagnoosiga patsientidel ning välja selgitada valuvaigistite kasutamist mõjutavad tegurid.Metoodika. Uuringus analüüsiti retrospektiivselt Tartu Kiirabis ajavahemikul 01.01.2018– 31.12.2018 ravitud täiskasvanud patsientide elektroonilisi kiirabikaarte, millel oli RHK-10 järgi põhidiagnoos S00–T98 (vigastused, mürgistused ja teatavad muud välispõhjuste toime tagajärjed). Andmete analüüsimiseks kasutati logistilist regressioonanalüüsi.Tulemused. Uuringus analüüsitud 1314 kiirabikaardist 529 (40,3%) kajastas ühe või enama valuvaigisti kasutamist. Valuvaigistite kasutamise tõenäosus vähenes 2,3 korda (95% uv 1,68–3,08; p < 0,0001) olukordades, kus patsient oli alkoholi tarvitamise tunnustega. Valu hindamist enne valuvaigisti manustamist dokumenteerisid õed brigaadijuhina 3,3 korda (95% uv 2,0–5,3; p < 0,001) suurema tõenäosusega kui arstidest brigaadijuhid. Võrreldes keskmise kiirabivisiidi pikkusega, manustati lühemate visiitide puhul (kuni 20 min) valuvaigisteid väiksema (OR (šansside suhe, odds ratio) 3,9; 95% uv 2,1–7; p < 0,001) ning üle 50 minuti kestvate visiitide puhul suurema tõenäosusega (50–60 min; OR 3,4; 95% uv 1,8–6,5; p < 0,001). Hospitaliseerimine vähendas valuvaigistite manustamise tõenäosust 1,59 korda (95% uv 1,13–2,24; p < 0,007).Järeldused. Uurimus näitas, et patsiendi joove, lühike visiidikestus ja hospitaliseerimine vähendasid patsientidele valuvaigistite manustamise tõenäosust, samal ajal kui pikk visiit suurendas valuvaigisti manustamise tõenäosust. Lisaks selgus, et õdedest brigaadijuhid hindavad ja dokumenteerivad patsientidel valu sagedamini kui arstid

Prehospital pain management of traumatically injured adult patients

Title Prehospital pain management of traumatically injured adult patients Authors Benström S Institute Uppsala University, Uppsala, Sweden Background and objective Traumatic injuries are a major cause behind moderate and severe pain in a prehospital setting. Therefore, the aim of this study is to evaluate prehospital use of analgesics among adult traumatically injured patients treated within Tartu Ambulance Foundation by analysing how ambulance personnel evaluates and treats pain. Secondary aim is to map prehospital factors influencing the process. Setting and Method A retrospective, single-centre service evaluation study with the primary selection of 7526 electronic patient records (EPR) with the main diagnosis of S00-T98 (ICD-10) was conducted and a polyvariant logistic regression model was created to map factors that influence pain management. Main outcome measures Primary outcome measures were prevalence of pain evaluation and the use of analgesics. Secondary outcome measures were significant changes in odds ratios for prehospital-related factors that affected primary outcome measures. Results Mean age of the study population was 54 years (SD 22) and 775 (58.9%) were male. Out of all the patients in this study 529 (40.3%) received analgesics. Pain assessment before administrating analgesics was documented on 15.9% of EPRs. Nurses assessed pain 3.3 times (95% CI 2.0-5.3; p<0.001) more likely than physicians. The odds for receiving analgesics were 2.3 (95% CI 1.68-3.08; p < 0,001) times smaller when patients had consumed alcohol. Brief assignment (0-10 min) and hospitalisation reduced the odds of using analgesics by 3.6 times (95% CI 1.9-6.8; p<0,001) and 1.59 times (95% CI 1.13-2.24; p<0.007) respectively while lengthy assignments (>50 min) increased the odds by 3.4 times (95% CI 1.9-6.5; p<0,001). Monotherapy was chosen for 73.2% of patients while 24.6% received a combination of 2 and 2.2% a combination of 3 analgesics.   Conclusions   Current study showed that although nurses as brigade leaders are more likely to assess pain the overall prevalence remains low. Alcohol consumption among patients, short assignment times, and hospitalization decreased the odds for pharmacological pain management. Longer assignment times on the contrary were associated with increased odds. Improvements in pain management can be made in choosing between specific therapeutic options

Prehospital pain management of traumatically injured adult patients

Title Prehospital pain management of traumatically injured adult patients Authors Benström S Institute Uppsala University, Uppsala, Sweden Background and objective Traumatic injuries are a major cause behind moderate and severe pain in a prehospital setting. Therefore, the aim of this study is to evaluate prehospital use of analgesics among adult traumatically injured patients treated within Tartu Ambulance Foundation by analysing how ambulance personnel evaluates and treats pain. Secondary aim is to map prehospital factors influencing the process. Setting and Method A retrospective, single-centre service evaluation study with the primary selection of 7526 electronic patient records (EPR) with the main diagnosis of S00-T98 (ICD-10) was conducted and a polyvariant logistic regression model was created to map factors that influence pain management. Main outcome measures Primary outcome measures were prevalence of pain evaluation and the use of analgesics. Secondary outcome measures were significant changes in odds ratios for prehospital-related factors that affected primary outcome measures. Results Mean age of the study population was 54 years (SD 22) and 775 (58.9%) were male. Out of all the patients in this study 529 (40.3%) received analgesics. Pain assessment before administrating analgesics was documented on 15.9% of EPRs. Nurses assessed pain 3.3 times (95% CI 2.0-5.3; p<0.001) more likely than physicians. The odds for receiving analgesics were 2.3 (95% CI 1.68-3.08; p < 0,001) times smaller when patients had consumed alcohol. Brief assignment (0-10 min) and hospitalisation reduced the odds of using analgesics by 3.6 times (95% CI 1.9-6.8; p<0,001) and 1.59 times (95% CI 1.13-2.24; p<0.007) respectively while lengthy assignments (>50 min) increased the odds by 3.4 times (95% CI 1.9-6.5; p<0,001). Monotherapy was chosen for 73.2% of patients while 24.6% received a combination of 2 and 2.2% a combination of 3 analgesics.   Conclusions   Current study showed that although nurses as brigade leaders are more likely to assess pain the overall prevalence remains low. Alcohol consumption among patients, short assignment times, and hospitalization decreased the odds for pharmacological pain management. Longer assignment times on the contrary were associated with increased odds. Improvements in pain management can be made in choosing between specific therapeutic options