Prehospital Pain Management in Trauma Treated by Helicopter Emergency Medical Services: Association of Patient and Physician Sex
Authors' conclusion
In this large cohort, we found sex-related differences in patient-reported analgesia: male patients were more likely than female patients to report insufficient analgesia. Treatment by male physicians was associated with better patient-reported analgesia. Ketamine and its combination with opioids were associated with greater patient-reported NRS reduction compared to opioid monotherapy in a prehospital setting.
Study context
- Population
- Trauma patients treated by a Swiss physician-staffed Helicopter Emergency Medical Service with Glasgow Coma Scale (GCS) ≥13, National Advisory Committee for Aeronautics (NACA) <VI, on-scene numeric rating scale (NRS) ≥3 and a second pain assessment at hospital arrival, 2020–2025of 43,024 missions
- Participants
- 5,168 patients
- Exposure
- Physician-patient sex pairings and analgesic regimens in relation to prehospital pain management
- Outcome
- Sufficient pain management (NRS ≤3)
- Follow-up
- At hospital arrival
Methodological detailssingle physician-staffed HEMS (Swiss)
- Single physician-staffed HEMS (Swiss)
Main finding
As reported in the abstract
Analgesia insufficient
32.2%
1663/5168; 95% CI, 30.9–33.3
Observational data: associations, not effects.
Further findings
Median
| Outcome | Ketamine | Combination therapy |
|---|---|---|
| Pain reduction (ΔNRS) by analgesic | 5 (IQR 3–6) | 5 (IQR 4–6) |
NRS reduction by physician sex
- Male physicians achieved greater NRS reduction
- 0.20 (Coef. 0.20; 95% CI, 0.12-0.28)
Pain relief by patient sex
- Male patients reported less pain relief
- −0.13 (Coef. −0.13; 95% CI, −0.21 to −0.05)
Higher initial NRS and insufficient analgesia
- Higher initial NRS associated with insufficient analgesia
- 1.45 (OR = 1.45; 95% CI, 1.39-1.51)
Omission of analgesics and insufficient analgesia
- Omission of analgesics associated with insufficient analgesia
- 5.70 (OR = 5.70; 95% CI, 4.54-7.15)
Opioid + ketamine combination and analgesia
- Opioid + ketamine combination associated with improved analgesia
- 0.69 (OR = 0.69; 95% CI, 0.58-0.83)
Pain reduction (ΔNRS) by analgesic
- Greatest pain reduction with ketamine or combination therapy
Original publication
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