Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis

Abstract 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...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Christopher Rugg, Simon Woyke, Julia Ausserer, Wolfgang Voelckel, Peter Paal, Mathias Ströhle
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Children Air ambulance Analgesia Accident Emergency medicine services Wounds and injuries Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/9771c7a1199848aba997ac5790870513
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:9771c7a1199848aba997ac5790870513
record_format	dspace
spelling	oai:doaj.org-article:9771c7a1199848aba997ac57908705132021-11-21T12:15:14ZAnalgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis10.1186/s13049-021-00978-z1757-7241https://doaj.org/article/9771c7a1199848aba997ac57908705132021-11-01T00:00:00Zhttps://doi.org/10.1186/s13049-021-00978-zhttps://doaj.org/toc/1757-7241Abstract 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.Christopher RuggSimon WoykeJulia AussererWolfgang VoelckelPeter PaalMathias StröhleBMCarticleChildrenAir ambulanceAnalgesiaAccidentEmergency medicine servicesWounds and injuriesMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENScandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 29, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Children Air ambulance Analgesia Accident Emergency medicine services Wounds and injuries Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Children Air ambulance Analgesia Accident Emergency medicine services Wounds and injuries Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Christopher Rugg Simon Woyke Julia Ausserer Wolfgang Voelckel Peter Paal Mathias Ströhle Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis
description	Abstract 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	article
author	Christopher Rugg Simon Woyke Julia Ausserer Wolfgang Voelckel Peter Paal Mathias Ströhle
author_facet	Christopher Rugg Simon Woyke Julia Ausserer Wolfgang Voelckel Peter Paal Mathias Ströhle
author_sort	Christopher Rugg
title	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_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_sort	analgesia in pediatric trauma patients in physician-staffed austrian helicopter rescue: a 12-year registry analysis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/9771c7a1199848aba997ac5790870513
work_keys_str_mv	AT christopherrugg analgesiainpediatrictraumapatientsinphysicianstaffedaustrianhelicopterrescuea12yearregistryanalysis AT simonwoyke analgesiainpediatrictraumapatientsinphysicianstaffedaustrianhelicopterrescuea12yearregistryanalysis AT juliaausserer analgesiainpediatrictraumapatientsinphysicianstaffedaustrianhelicopterrescuea12yearregistryanalysis AT wolfgangvoelckel analgesiainpediatrictraumapatientsinphysicianstaffedaustrianhelicopterrescuea12yearregistryanalysis AT peterpaal analgesiainpediatrictraumapatientsinphysicianstaffedaustrianhelicopterrescuea12yearregistryanalysis AT mathiasstrohle analgesiainpediatrictraumapatientsinphysicianstaffedaustrianhelicopterrescuea12yearregistryanalysis
_version_	1718419139762061312

Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis

Ejemplares similares