The journal of trauma and acute care surgery | 2021
Trends in pre-hospital pain management following the introduction of new clinical practice guidelines.
Abstract
BACKGROUND\nEarly pain treatment following injury has been shown to improve long-term outcomes, while untreated pain can facilitate higher post-traumatic stress disorder (PTSD) rates and worsen outcomes. Nonetheless, trauma casualties frequently receive inadequate analgesia. In June 2013, a new clinical practice guideline (CPG) regarding pain management was introduced in the IDF Medical Corps, recommending oral transmucosal fentanyl citrate (OTFC) and low dose IV/IM ketamine. The purpose of this study is to examine trends in pre-hospital pain management in the IDF.\n\n\nMETHODS\nAll cases documented in the Israel Defense Forces trauma registry between 2008 and 2020 were examined. This study compared casualty parameters before and after the introduction of analgesia CPG in 2013. Parameters compared included demographics, injury parameters, treatment modalities, and types of analgesia provided.\n\n\nRESULT\nOverall, 5,653 casualties were included in our study. During the six years before the introduction of the CPG, 289/1084 (26.7%) casualties received an analgesic treatment, compared with 1578/4569 (34.5%) casualties during the seven years following (P < 0.001). Since its introduction, OTFC was administered to 41.8% of all casualties who received analgesia and became the most used analgesic drug in 2020 (61.1% of casualties receiving analgesia). The rate of intravenous morphine significantly decreased after 2013 (22.6% to 16%, P < 0.001).\n\n\nCONCLUSIONS\nPain management has become more common in trauma patients pre-hospital care in the IDF in recent years. There has been a significant increase in analgesia administration, with the increased use of OTFC, along with a significant reduction in the use of IV morphine. These results may be attributed to introducing a pain management CPG and implementing OTFC among medical teams. The perception of OTFC as a safe, user-friendly analgesic may have contributed to its use by medical providers, increasing analgesia rates overall.\n\n\nLEVEL OF EVIDENCE\nIII.