Pain Management in a Prehospital Emergency Setting: A Retrospective Observational Study

Figures & data

Table 1 Distribution of NRS Levels of Pain at the First Assessment

NRS Level of Pain	n	%
Absent pain (NRS = 0)	253	53.3
Mild pain (NRS range 1–3)	68	14.3
Moderate pain (NRS range 4–6)	79	16.6
Severe pain (NRS range 7–10)	75	15.8
Total	475	100

Table 2 Distribution of NRS Levels of Pain in Relation to the Prehospital Emergency Vehicle

NRS Level of Pain	Nurse-Staffed Ambulances n (%)	Medical Cars n (%)	Total n (%)
Absent pain	123 (53.9)	130 (52.6)	253 (53.3)
Mild pain	44 (19.3)	24 (9.7)	68 (14.3)
Moderate pain	28 (12.3)	51 (20.6)	79 (16.6)
Severe pain	33 (14.5)	42 (17)	75 (15.8)
Total	228 (100)	247 (100)	475 (100)

Table 3 Distribution of NRS Levels of Pain in Relation to Type of Event

NRS Level of Pain	Traumatic Injury n (%)	Medical Condition n (%)	Total n (%)
Absent pain	19 (17.9)	229 (63.8)	248 (53.3)
Mild pain	29 (27.4)	35 (9.7)	64 (13.8)
Moderate pain	30 (28.3)	48 (13.4)	78 (16.8)
Severe pain	28 (26.4)	47 (13.1)	75 (16.1)
Total	106 (100)	359 (100)	465 (100)

Table 4 Distribution of NRS Levels of Pain by Age Classes

NRS Level of Pain	18–44 Years n (%)	45–64 Years n (%)	65–85 Years n (%)	≥86 Years n (%)	Total n (%)
Absent pain	36 (33.6)	47 (44.8)	123 (62.8)	47 (70.1)	253 (53.3)
Mild pain	21 (19.6)	18 (17.1)	20 (10.2)	9 (13.4)	68 (14.3)
Moderate pain	21 (19.6)	25 (23.8)	25 (12.8)	8 (11.9)	79 (16.6)
Severe pain	29 (27.1)	15 (14.3)	28 (14.3)	3 (4.5)	75 (15.8)
Total	107 (100)	105 (100)	196 (100)	67 (100)	475 (100)

Table 5 Pharmacological Treatment in Relation to Levels of Pain in Nurse-Staffed Ambulances

	No Pharmacological Treatment n (%)	Paracetamol n (%)	Ketorolac n (%)	Fentanyl n (%)	Morphine n (%)	Total n (%)
Absent pain	122 (99.2)	1 (0.8)	0 (0)	0 (0)	0 (0)	123 (100)
Mild pain	44 (100)	0 (0)	0 (0)	0 (0)	0 (0)	44 (100)
Moderate pain	27 (96.4)	0 (0)	1 (3.6)	0 (0)	0 (0)	28 (100)
Severe pain	20 (60.6)	0 (0)	0 (0)	10 (30.3)	3 (9.1)	33 (100)
Total	213 (93.4)	1 (0.4)	1 (0.4)	10 (4.4)	3 (1.3)	228 (100)

Notes: Legend: The areas in yellow indicate that the pain has not been treated according to the clinical-care algorithm; on the contrary the areas in green indicate situations in accordance with the indications of the algorithm. The areas in orange correspond to situations in which pharmacological treatment has been administered for reasons other than pain.

Table 6 Pharmacological Treatment in Relation to Levels of Pain in Medical Cars

	No Pharmacological Treatment n (%)	Paracetamol n (%)	Ketorolac n (%)	Fentanyl n (%)	Morphine n (%)	Total n (%)
Absent pain	117 (90)	11 (8.5)	0 (0)	0 (0)	2 (1.5)	130 (100)
Mild pain	22 (91.7)	1 (4.2)	1 (4.2)	0 (0)	0 (0)	24 (100)
Moderate pain	42 (82.4)	3 (5.9)	2 (3.9)	1 (2)	3 (5.9)	51 (100)
Severe pain	22 (52.4)	4 (9.5)	6 (14.3)	9 (21.4)	1 (2.4)	42 (100)
Total	203 (82.2)	19 (7.7)	9 (3.6)	10 (4)	6 (2.4)	247 (100)

Notes: Legend: The areas in yellow indicate that the pain has not been treated according to the clinical-care algorithm; on the contrary the areas in green indicate situations in accordance with the indications of the algorithm. The areas in orange correspond to situations in which pharmacological treatment has been administered for reasons other than pain.

Table 7 Pharmacological Treatment Distributed by Type of Event and Levels of Pain

NRS Level of Pain	Pharmacological Treatment	Traumatic Injury n (%)	Medical Condition n (%)	p-value
Mild pain	No treatment	29 (100)	33 (94.3)	NS
	Paracetamol	0 (0)	1 (2.9)
	Ketorolac	0 (0)	1 (2.9)
	Fentanyl	0 (0)	0 (0)
	Morphine	0 (0)	0 (0)
Moderate pain	No treatment	27 (90)	41 (85.4)	NS
	Paracetamol	0 (0)	3 (6.3)
	Ketorolac	2 (6.7)	1 (2.1)
	Fentanyl	1 (3.3)	0 (0)
	Morphine	0 (0)	3 (6.3)
Severe pain	No treatment	9 (32.1)	33 (70.2)	p=0.001
	Paracetamol	1 (3.6)	3 (6.4)
	Ketorolac	1 (3.6)	5 (10.6)
	Fentanyl	17 (60.7)	2 (4.3)
	Morphine	0 (0)	4 (8.5)
Total	No treatment	65 (74.7)	107 (82.3)	p=0.001
	Paracetamol	1 (1.1)	7 (5.4)
	Ketorolac	3 (3.4)	7 (5.4)
	Fentanyl	18 (20.7)	2 (1.5)
	Morphine	0 (0)	7 (5.4)

Table 8 Pharmacological Treatment Distributed by Levels of Pain and by Sex

Sex	Pharmacological Treatment	Mild Pain n (%)	Moderate Pain n (%)	Severe Pain n (%)
Female	Paracetamol	0 (0)	3 (50)	3 (15)
	Ketorolac	0 (0)	2 (33.3)	5 (25)
	Fentanyl	0 (0)	0 (0)	10 (50)
	Morphine	0 (0)	1 (16.7)	2 (10)
Total		0 (0)	6 (100)	20 (100)
Male	Paracetamol	1 (50)	0 (0)	1 (7.7)
	Ketorolac	1 (50)	1 (25)	1 (7.7)
	Fentanyl	0 (0)	1 (25)	9 (69.2)
	Morphine	0 (0)	2 (50)	2 (15.4)
Total		2 (100)	4 (100)	13 (100)

Table 9 Pharmacological Treatment Distributed by Levels of Pain and by Age Classes

	Mild Pain				Moderate Pain				Severe Pain				Total
	18–44 n (%)	45–64 n (%)	65–85 n (%)	≥86 n (%)	18–44 n (%)	45–64 n (%)	65–85 n (%)	≥86 n (%)	18–44 n (%)	45–64 n (%)	65–85 n (%)	≥86 n (%)
No pharmacological treatment	20 (95.2)	17 (94.4)	20 (100)	9 (100)	20 (95.2)	23 (92)	18 (72)	8 (100)	15 (51.7)	8 (53.3)	18 (64.3)	1 (33.3)	177 (79.7)
Paracetamol	1 (4.8)	0	0	0	0	1 (4)	2 (8)	0	2 (6.9)	0	2 (7.1)	0	8 (3.6)
Ketorolac	0	1 (5.6)	0	0	1 (4.8)	1 (4)	1 (4)	0	1 (3.4)	2 (13.3)	3 (10.7)	0	10 (4.5)
Fentanyl	0	0	0	0	0	0	1 (4)	0	11 (37.9)	4 (26.7)	3 (10.7)	1 (33.3)	20 (9)
Morphine	0	0	0	0	0	0	3 (12)	0	0	1 (6.7)	2 (7.1)	1 (33.3)	7 (3.2)
Total	21 (100)	18 (100)	20 (100)	9 (100)	21 (100)	25 (100)	25 (100)	8 (100)	29 (100)	15 (100)	28 (100)	3 (100)	222 (100)