Pre-Hospital Administration of Opioids in Trauma Patients: Is Dose Associated With Outcomes?

Letitia Bible, Omar Obaid, Muhammad Khurrum, Mei Goh, Ahmad Hammad, Daniel James Kitts, Tanya Anand, Meera Kapadia, Bellal Joseph

Research output: Contribution to journalArticlepeer-review


Background: Opioids are commonly used as an analgesic agent in the prehospital setting. Current efforts to prevent and control prescription opioid overuse are focused on the in-hospital and post-discharge phases. The aim of our study was to assess the associations between pre-hospital opioids use and in-hospital outcomes among trauma patients. Methods: We performed a 2 year (2016-2017) retrospective analysis of our Level-I trauma center database. We included all adult trauma patients (age > 18y) who received pre-hospital opioids (Fentanyl (F) or Morphine-Sulfate (MS)). Outcome measures were emergency-department (ED) hypotension (SPB < 90 mmHg), ED intubation, prescription opioid medication upon discharge, and mortality. Multivariate logistic regression was performed. Results: In total, 709 patients were included in the analysis. Cutoff values of 200 mcg F and 15 mg MS were significantly associated with adverse outcomes. Overall, the ED hypotension rate was 14.4%, ED intubation rate was 6%, and ED mortality rate was 3.1%. On regression analysis, higher dosages of both pre-hospital F and pre-hospital MS were independently associated with increased odds of ED hypotension, ED intubation, and discharge on opioid medications, but not with ED mortality. Conclusion: Pre-hospital administration of high dose opioids is associated with increased odds of adverse outcomes. Collaborative efforts to standardize and control the overuse of opioids should target the pre-hospital setting to limit opioid associated adverse effects.

Original languageEnglish (US)
Pages (from-to)634-642
Number of pages9
JournalJournal of Surgical Research
StatePublished - Dec 2021


  • Fentanyl
  • Intubation
  • Morphine-Sulfate
  • Opioids
  • Pre-hospital
  • Trauma

ASJC Scopus subject areas

  • Surgery


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