Ambulance call triage outcomes for patients reporting pain: A retrospective cross-sectional analysis of pain score versus triage level

Abstract

Objective: To identify any association between the response priority code generated during calls to the ambulance communication centre and patient reports of pain severity. Methods: A retrospective analysis of patient care records was undertaken for all patients transported by paramedics over a 7-day period. The primary research interest was the association between the response code allocated at the time of telephone triage and the initial pain severity score recorded using a numeric rating scale (NRS). Univariate and multivariate logistic regression methods were used to analyse the association between the response priority variable and explanatory variables. Results: There were 1246 cases in which both an initial pain score using the NRS and a response code were recorded. Of these cases, 716/1246 (57.5%) were associated with a code 1 ("time-critical") response. After adjusting for gender, age, cause of pain and duration of pain, a multivariate logistic regression analysis found no significant change in the odds of a patient in pain receiving a time-critical response compared with patients who had no pain, regardless of their initial pain score (NRS 1-3, odds ratio (OR) 1.11, 95% CI 0.7 to 1.8; NRS 4-7, OR 1.12, 95% CI 0.7 to 1.8; NRS 8-10, OR 0.84, 95% CI 0.5 to 1.4). Conclusion: The severity of pain experienced by the patient appeared to have no influence on the priority (urgency) of the dispatch response. Triage systems used to prioritise ambulance calls and decide the urgency of response or type of referral options should consider pain severity to facilitate timely and humane care.