ABSTRACTS
Subjective versus Objective Pain: An ExplorationAuthor: Ginny Kaplan PhD, MHS, Paramedic, FAEMS | Department Chair & Assistant Professor | Methodist University Associate Authors: Hubble, Michael W., PhD, MBA, NRP | Reyes, Luis G., AS, AAS, Paramedic
Introduction Insufficient literature exists on the potential for disparities in pain management based on whether the pain reported by the patient is unable to be seen by the paramedic (subjective) or is visible to the paramedic due to an injurious process (objective). Objective To determine if treatment disparities exist between reported subjective versus objective pain. Methods Analyses were conducted using the 2023 ESO Data Collaborative. Patients were included if they were >18 years old, had an initial systolic blood pressure >90mmHg, and had a documented pain score from >7. Pregnant patients were excluded due to the fetal risk of opiate analgesics. Using primary and secondary impressions, patients were dichotomized into groups of subjectively and objectively reported pain. Descriptive statistics analyzed the sample, and a logistic regression was computed the determine predictors of narcotic analgesia administration (Hydromorphone, Fentanyl, Ketamine, Midazolam, or Morphine), while controlling for potential confounders. An area under the curve of the receiver operating characteristic (AUCROC) was calculated for the determination of model predictability. Results A total of 57,646 patients were included in the analysis. Of those, 59.5% were female, 32.7% were of a minority race, and 33.8% reported subjective pain. The mean (±SD) age was 56.34 (±19.25). Females and minorities were 9.6% and 48% less likely to receive narcotic analgesia, respectively. When patients reported pain that was objectively obvious were 2.4 times more likely to receive narcotic analgesia compared to patients who reported subjective pain (OR: 2.42; 95%CI: 2.33–2.52). Patient weight was not statistically significant in this model. The AUCROC showed a model predictability of 64%. Conclusion In our model, patients who reported objective were 2.4 times more likely to be treated compared to patients reporting subjective pain when other demographic factors influencing analgesia administration were held constant. Further research should be undertaken to explore disparities in narcotic analgesia administration, particularly related to the overtness of the pain experienced.
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