Abstract：
OBJECTIVE: Patients with hip fractures frequently present at the emergency department (ED). Despite high pain scores, prehospital pain management is often inadequate and insufficient. In the Netherlands, the emergency medical services (EMS) exhibit a high level of training, supported by a comprehensive pain treatment protocol. This study aimed to assess adherence to the protocol and hypothesized that prehospital pain management in hip fracture patients was both sufficient and adequate.
METHODS: This was a retrospective observational cohort study of patients with suspected hip fractures. The median differences in numerical rating scale (NRS) pain scores between the initial score in the ambulance and upon arrival at the ED were compared. Furthermore, adherence to the ambulance pain protocol was studied.
RESULTS: From September 2016 to March 2021, 436 ambulance-transported hip fracture patients were included, of whom 81% received analgesics by EMS. The median initial pain score measured by EMS was 8; this number decreased to 5 at ED presentation, a significant decrease (ρ < 0.001). In case a prehospital NRS pain score was assessed, 66.5% of the patients were treated according to the protocol. In 80% of patients, the protocol was not followed correctly, primarily due to missing NRS pain scores.
CONCLUSIONS: In suspected hip fracture patients, initial prehospital pain scores were high and most patients received analgesics from EMS. This resulted in a significant decrease in pain. In nearly 67% of patients in whom an NRS pain score was assessed in the prehospital phase, pain management was according to protocol. However, in 80% of the total population the pain protocol was not adhered to, mainly due to missing NRS pain scores.
METHODS: This was a retrospective observational cohort study of patients with suspected hip fractures. The median differences in numerical rating scale (NRS) pain scores between the initial score in the ambulance and upon arrival at the ED were compared. Furthermore, adherence to the ambulance pain protocol was studied.
RESULTS: From September 2016 to March 2021, 436 ambulance-transported hip fracture patients were included, of whom 81% received analgesics by EMS. The median initial pain score measured by EMS was 8; this number decreased to 5 at ED presentation, a significant decrease (ρ < 0.001). In case a prehospital NRS pain score was assessed, 66.5% of the patients were treated according to the protocol. In 80% of patients, the protocol was not followed correctly, primarily due to missing NRS pain scores.
CONCLUSIONS: In suspected hip fracture patients, initial prehospital pain scores were high and most patients received analgesics from EMS. This resulted in a significant decrease in pain. In nearly 67% of patients in whom an NRS pain score was assessed in the prehospital phase, pain management was according to protocol. However, in 80% of the total population the pain protocol was not adhered to, mainly due to missing NRS pain scores.
摘要：
目的：髋部骨折患者常在急诊科就诊。尽管疼痛评分很高，院前疼痛管理往往是不充分的。在荷兰,紧急医疗服务（EMS）表现出高水平的培训，由全面的疼痛治疗方案支持。这项研究旨在评估对协议的依从性，并假设髋部骨折患者的院前疼痛管理既充分又充分。
方法：这是一项对疑似髋部骨折患者的回顾性观察性队列研究。比较了救护车中的初始评分与到达ED时的数字评定量表（NRS）疼痛评分的中位数差异。此外，对救护车疼痛方案的依从性进行了研究。
结果：从2016年9月到2021年3月，包括436名救护车运送的髋部骨折患者，其中81%的人通过EMS接受了镇痛药。EMS测量的初始疼痛评分中位数为8；在ED演示时，该数字降至5，显著下降(ρ<0.001)。如果评估院前NRS疼痛评分，66.5%的患者按照方案治疗。在80%的患者中，协议没有被正确遵循，主要是由于缺少NRS疼痛评分。
结论：在疑似髋部骨折患者中，最初院前疼痛评分较高,大多数患者接受EMS止痛药.这导致疼痛的显著减少。在院前阶段评估NRS疼痛评分的患者中，近67%疼痛管理按照协议进行.然而,在80%的总人口中，疼痛方案没有得到遵守，主要是由于缺少NRS疼痛评分。
方法：这是一项对疑似髋部骨折患者的回顾性观察性队列研究。比较了救护车中的初始评分与到达ED时的数字评定量表（NRS）疼痛评分的中位数差异。此外，对救护车疼痛方案的依从性进行了研究。
结果：从2016年9月到2021年3月，包括436名救护车运送的髋部骨折患者，其中81%的人通过EMS接受了镇痛药。EMS测量的初始疼痛评分中位数为8；在ED演示时，该数字降至5，显著下降(ρ<0.001)。如果评估院前NRS疼痛评分，66.5%的患者按照方案治疗。在80%的患者中，协议没有被正确遵循，主要是由于缺少NRS疼痛评分。
结论：在疑似髋部骨折患者中，最初院前疼痛评分较高,大多数患者接受EMS止痛药.这导致疼痛的显著减少。在院前阶段评估NRS疼痛评分的患者中，近67%疼痛管理按照协议进行.然而,在80%的总人口中，疼痛方案没有得到遵守，主要是由于缺少NRS疼痛评分。
