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Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis
BACKGROUND: As pediatric patients are typically rare among helicopter emergency medical systems (HEMS), children might be at risk for oligo-analgesia due to the rescuer’s lack of experience and the fear of side effects. METHODS: In this retrospective analysis, data was obtained from the ÖAMTC HEMS d...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600762/ https://www.ncbi.nlm.nih.gov/pubmed/34794486 http://dx.doi.org/10.1186/s13049-021-00978-z |
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author | Rugg, Christopher Woyke, Simon Ausserer, Julia Voelckel, Wolfgang Paal, Peter Ströhle, Mathias |
author_facet | Rugg, Christopher Woyke, Simon Ausserer, Julia Voelckel, Wolfgang Paal, Peter Ströhle, Mathias |
author_sort | Rugg, Christopher |
collection | PubMed |
description | BACKGROUND: As pediatric patients are typically rare among helicopter emergency medical systems (HEMS), children might be at risk for oligo-analgesia due to the rescuer’s lack of experience and the fear of side effects. METHODS: In this retrospective analysis, data was obtained from the ÖAMTC HEMS digital database including 14 physician staffed helicopter bases in Austria over a 12-year timeframe. Primary missions involving pediatric trauma patients (< 15 years) not mechanically ventilated on-site were included. Analgesia was assessed and compared between the age groups 0–5, 6–10 and 11–14 years. RESULTS: Of all flight missions, 8.2% were dedicated to children < 15 years. Analgetic drugs were administered in 31.4% of all primary missions (3874 of 12,324), wherefrom 2885 were injured and non-ventilated (0–5 yrs.: n = 443; 6–10 yrs.: n = 902; 11–14 yrs.: n = 1540). The majority of these patients (> 75%) suffered moderate to severe pain, justifying immediate analgesia. HEMS physicians typically chose a monotherapy with an opioid (n = 1277; 44.3%) or Esketamine (n = 1187; 41.1%) followed by the combination of both (n = 324; 11.2%). Opioid use increased (37.2% to 63.4%) and Esketamine use decreased (66.1% to 48.3%) in children < 6 vs. > 10 years. Esketamine was more often administered in extremity (57.3%) than in head (41.5%) or spine injuries (32.3%). An intravenous access was less often established in children < 6 years (74.3% vs. 90.8%; p < 0.001). Despite the use of potent analgesics, 396 missions (13.7%) were performed without technical monitoring. Particularly regarding patient data at handover in hospital, merely < 10% of all missions featured complete documentation. Therefore, sufficient evaluation of the efficacy of pain relief was not possible. Yet, by means of respiratory measures required during transport, severe side effects such as respiratory insufficiency, were barely noted. CONCLUSIONS: In the physician-staffed HEMS setting, pediatric trauma patients liberally receive opioids and Esketamine for analgesia. With regard to severe respiratory insufficiency during transport, the application of these potent analgesics seems safe. |
format | Online Article Text |
id | pubmed-8600762 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-86007622021-11-19 Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis Rugg, Christopher Woyke, Simon Ausserer, Julia Voelckel, Wolfgang Paal, Peter Ströhle, Mathias Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: As pediatric patients are typically rare among helicopter emergency medical systems (HEMS), children might be at risk for oligo-analgesia due to the rescuer’s lack of experience and the fear of side effects. METHODS: In this retrospective analysis, data was obtained from the ÖAMTC HEMS digital database including 14 physician staffed helicopter bases in Austria over a 12-year timeframe. Primary missions involving pediatric trauma patients (< 15 years) not mechanically ventilated on-site were included. Analgesia was assessed and compared between the age groups 0–5, 6–10 and 11–14 years. RESULTS: Of all flight missions, 8.2% were dedicated to children < 15 years. Analgetic drugs were administered in 31.4% of all primary missions (3874 of 12,324), wherefrom 2885 were injured and non-ventilated (0–5 yrs.: n = 443; 6–10 yrs.: n = 902; 11–14 yrs.: n = 1540). The majority of these patients (> 75%) suffered moderate to severe pain, justifying immediate analgesia. HEMS physicians typically chose a monotherapy with an opioid (n = 1277; 44.3%) or Esketamine (n = 1187; 41.1%) followed by the combination of both (n = 324; 11.2%). Opioid use increased (37.2% to 63.4%) and Esketamine use decreased (66.1% to 48.3%) in children < 6 vs. > 10 years. Esketamine was more often administered in extremity (57.3%) than in head (41.5%) or spine injuries (32.3%). An intravenous access was less often established in children < 6 years (74.3% vs. 90.8%; p < 0.001). Despite the use of potent analgesics, 396 missions (13.7%) were performed without technical monitoring. Particularly regarding patient data at handover in hospital, merely < 10% of all missions featured complete documentation. Therefore, sufficient evaluation of the efficacy of pain relief was not possible. Yet, by means of respiratory measures required during transport, severe side effects such as respiratory insufficiency, were barely noted. CONCLUSIONS: In the physician-staffed HEMS setting, pediatric trauma patients liberally receive opioids and Esketamine for analgesia. With regard to severe respiratory insufficiency during transport, the application of these potent analgesics seems safe. BioMed Central 2021-11-18 /pmc/articles/PMC8600762/ /pubmed/34794486 http://dx.doi.org/10.1186/s13049-021-00978-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Original Research Rugg, Christopher Woyke, Simon Ausserer, Julia Voelckel, Wolfgang Paal, Peter Ströhle, Mathias Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title | Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_full | Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_fullStr | Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_full_unstemmed | Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_short | Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_sort | analgesia in pediatric trauma patients in physician-staffed austrian helicopter rescue: a 12-year registry analysis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600762/ https://www.ncbi.nlm.nih.gov/pubmed/34794486 http://dx.doi.org/10.1186/s13049-021-00978-z |
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