Prehospital Pain Management for Injured Patients at the Intersection of Sex and Obesity A Retrospective Observational Study
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Abstract
Objectives: We investigated the association of obesity with analgesia administration and pain reduction for prehospital patients with traumatic injuries.
Methods: Using the 2022 ESO Data Collaborative, we analyzed emergency medical services (EMS) records for 9-1-1 transports of adult patients with injuries. Patients with primary impressions related to behavioral, neurologic, respiratory, and cardiac emergencies, Glasgow Coma Scale of < 15, non-alert on AVPU scale, or no race/weight documented were excluded. Weight status was categorized using the Center for Disease Control (CDC) Body Mass Index (BMI) thresholds, with BMI calculated from documented weight, race/ethnicity, and gender using CDC height averages. We analyzed the relationship between BMI category, analgesia administration, and pain reduction using bivariate and multivariable logistic regression.
Results: Of 482,592 patients in the analysis, 164,175 (34.0%) were classified as obese (BMI ≥ 30 kg/m2). Analgesia administration and pain reduction were more likely for patients with obesity (aOR 1.13, 95% CI: 1.10-1.17; aOR 1.06, 95% CI: 1.02-1.10) than those without obesity. Men with obesity were more likely than men without obesity to receive analgesia (aOR 1.21, 95% CI: 1.17-1.24) but women with obesity were not more likely than women without obesity to receive analgesia (aOR 0.97, 95% CI: 0.95-1.00).
Conclusions: Patients with obesity were more likely to receive analgesia by EMS than those without obesity, but this advantage did not exist for women. Limitations to this study include using a convenience sample and calculating a BMI from epidemiological data on average height. Further research should explore the mechanisms underpinning the treatment advantage for men with obesity that does not extend to not women with obesity.
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