Sources of Discomfort and Treatment Strategies for Trauma Patients in the Pre-Hospital Setting-A Scoping Review.

Abstract

Introduction: Trauma remains a leading cause of mortality and long-term disability worldwide, often causing significant discomfort during prehospital care. Addressing these discomforts effectively is crucial for improving patient outcomes. This scoping review aimed to identify and categorize the types of discomforts experienced by adult trauma victims in prehospital settings and map the pharmacologic and nonpharmacologic interventions used to mitigate them.

Methods: This scoping review followed the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search was performed in databases including MEDLINE, CINAHL, Scopus, Embase, PsycINFO, Joanna Briggs Institute Evidence Synthesis, Cochrane Database, and relevant gray literature sources. Studies involving adult trauma patients (≥18 years) in prehospital care that reported on discomfort and interventions were included without restrictions on publication date.

Results: Seventeen studies met the inclusion criteria, covering various international contexts. Acute pain was the most frequently reported discomfort, followed by anxiety, fear, cold-induced discomfort, and discomfort caused by immobilization. Pharmacologic interventions predominantly included opioids, nonsteroidal anti-inflammatory drugs, paracetamol, ketamine, and methoxyflurane, whereas nonpharmacologic interventions comprised acupressure, transcutaneous electrical nerve stimulation, cryotherapy, warming measures, communication strategies, and emotional support. Nonpharmacologic interventions, especially acupressure and communication techniques, showed promising results in reducing pain and anxiety.

Discussion: The findings underline the multidimensional nature of discomfort in prehospital trauma care and highlight effective interventions, including pharmacologic and complementary nonpharmacologic strategies. However, significant gaps remain regarding standardized assessment tools for non-pain-related discomforts and combined interventions. This review underscores the necessity for comprehensive management protocols and further research to optimize patient comfort and care outcomes in trauma settings.