Pain and Heart Failure During Transport by Emergency Medical Services and Its Associated Outcomes: Hospitalization, Mortality, and Length of Stay.

This was a retrospective record review from one large urban Midwestern county, so results may not apply to rural areas or patients who did not use EMS. Heart failure was self-reported in EMS records and was not confirmed by echocardiography or left ventricular ejection fraction. The pain data recorded only the primary complaint and location. They did not distinguish acute from chronic pain, pain subtype, severity, or whether pain was treated. Patients in the non-pain group could still have had pain that was not recorded as the primary complaint. BNP was available for only 1,709 of 3,539 patients and was not used in the regression models. Only 21 patients with a pain primary complaint died in hospital. This limits mortality analysis by pain location. The length-of-stay model accounted for a small amount of variation (R2 = 0.0459), and many factors such as medications at admission, edema, living status, and precipitating events were not available. The study did not measure EMS or hospital treatment, so it cannot say whether pain care changed outcomes.

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Do not conclude that pain is protective or that EMS pain complaints can be deprioritized. The study only shows an association with lower hospitalization and shorter stay, and it did not measure whether pain was treated, how severe it was, or whether acute and chronic pain differed.