Ketamine for Acute Pain Management After Trauma

Primary Outcomes

• Average Daily Opioid Use as Measured by the Morphine Milligram Equivalents (MME) Per Day In-hospital days (up to 6 weeks post hospital admission)

Secondary Outcomes

• Pain as Assessed by Score on the Numeric Rating Scale (NRS) Hospital discharge (up to 6 weeks post hospital admission)

  The NRS ranges from 0 (no pain) to 10 (worst pain), with a higher score indicating a worse outcome. This scale is used in verbal participants.

• Number of Patients That Showed Signs of Delirium During In-hospital Stay Hospital discharge (up to 6 weeks post hospital admission)

  Incidence of delirium during in-hospital stay

• Number of Patients That Required Unplanned Intubation During In-hospital Stay Hospital discharge (up to 6 weeks post hospital admission)

  incidence of need for unplanned intubation during in-hospital stay

• Number of Patients Who Required Unplanned Admission to Intensive Care Unit During In-hospital Stay Hospital discharge (up to 6 weeks post hospital admission)

  Incidence of need for unplanned admission to an ICU

• Initiation of Ketamine Drip Hospital discharge (up to 6 weeks post hospital admission)

  Time from admission to time Ketamine drip started

• Duration of Ketamine Drip Hospital discharge (up to 6 weeks post hospital admission)

  Length of time Ketamine drip was infused

• Number of Patients Requesting to Discontinue Ketamine Hospital discharge (up to 6 weeks post hospital admission)

  Number of patients requesting to stop Ketamine for any complaint

• Use of Other Pain Control Adjuncts Including Regional Anesthesia and Lidocaine Patch Hospital discharge (up to 6 weeks post hospital admission)

  Incidence of use of additional pain control adjuncts such as regional anesthesia and lidocaine patch during hospitalization

• Ventilator Free Days Hospital discharge (up to 6 weeks post hospital admission)

  Number of inpatient hospital days patients did not require mechanical ventilation

• ICU Free Days Hospital discharge (up to 6 weeks post hospital admission)

  Number of inpatient hospital days patients did not require ICU level of care

• Hospital Free Days 30 days post admission

  Number of days patients were not in the hospital during the first 30 days after admission

• Number of Patients Discharged From the Hospital With an Opioid Prescription Hospital discharge (up to 6 weeks post hospital admission)

  Number of patients discharged from the hospital with an opioid prescription

• Number of Patients Who Reported Continued Pain Continued Post-traumatic Pain at 6 Months Post Admission 6 months post admission

  Number of patients who reported continued pain at 6 months following trauma injury

• Number of Patients Who Continue to Use Opioids at 6 Months Post Admission 6 months post admission

  Number of patients who continue to use opioids

• Post Traumatic Stress Disorder (PTSD) as Assessed by the PC-PTSD-5 Questionnaire 6 months post admission

  The PC-PTSD-5 questionnaire asks the below 5 questions, and data are reported categorically as the number of participants who responded "yes" to each of the 5 questions. An answer of "yes" is indicative of a PTSD symptom, which is a worse outcome. 1. In the past month, have you had nightmares about the events or thought about the events when you did not want to? 2. In the past month, have you tried hard not to think about the events or went out of your way to avoid situations that reminded you of the events? 3. In the past month, have you been constantly on guard, watchful, or easily startled? 4. In the past month, have you felt numb or detached from people, activities, or your surroundings? 5. In the past month, have you felt guilty or unable to stop blaming yourself or others for the events or any problems the events may have caused?

• Risk of Future Opioid Abuse as Assessed by the Opioid Risk Tool (ORT) Hospital discharge (about 1 to 6 weeks after admission)

  Total ORT score ranges from 0 to 26. A score of 3 or lower indicates low risk for future opioid abuse, a score of 4 to 7 indicates moderate risk for opioid abuse, and a score of 8 or higher indicates a high risk for opioid abuse.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Mobility) Hospital discharge (about 1 to 6 weeks after admission)

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their level of mobility by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Self-Care) Hospital discharge (about 1 to 6 weeks after admission)

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their level of self-care by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Usual Activities) Hospital discharge (about 1 to 6 weeks after admission)

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their ability to carry out usual activities by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Pain/Discomfort) Hospital discharge (about 1 to 6 weeks after admission)

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their level of pain/discomfort by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Anxiety/Depression) Hospital discharge (about 1 to 6 weeks after admission)

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their level of anxiety/depression by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Current Health) Hospital discharge (about 1 to 6 weeks after admission)

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked the question "How would you rate your health today?," and they respond with a score from 0 - 100, with a higher score indicating a better outcome.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Previous Experience) Hospital discharge (about 1 to 6 weeks after admission)

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked the question "Have you ever experience this kind of event?," and data are reported as the number of participants who responded "yes."

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Mobility) 6 months post admission

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their level of mobility by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Self-Care) 6 months post admission

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their level of mobility by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Usual Activities) 6 months post admission

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their ability to carry out usual activities by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Pain/Discomfort) 6 months post admission

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their level of pain/discomfort by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Anxiety/Depression) 6 months post admission

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked to indicate their level of anxiety/depression by choosing a predefined category, and the data for this outcome are reported categorically as the number of participants who chose each category.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Current Health) 6 months post admission

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked the question "How would you rate your health today?," and they respond with a score from 0 - 100, with a higher score indicating a better outcome.

• Health Status as Assessed by the Euro-QOL EQ-5D-3L Questionnaire (Previous Experience) 6 months post admission

  For this item of the Euro-QOL EQ-5D-3L questionnaire, participants are asked the question "Have you ever experience this kind of event?," and data are reported as the number of participants who responded "yes."

• Post Traumatic Stress Disorder (PTSD) as Assessed by the PC-PTSD-5 Questionnaire Hospital discharge (about 1 to 6 weeks after admission)

  The PC-PTSD-5 questionnaire asks the below 5 questions, and data are reported categorically as the number of participants who responded "yes" to each of the 5 questions. An answer of "yes" is indicative of a PTSD symptom, which is a worse outcome. 1. In the past month, have you had nightmares about the events or thought about the events when you did not want to? 2. In the past month, have you tried hard not to think about the events or went out of your way to avoid situations that reminded you of the events? 3. In the past month, have you been constantly on guard, watchful, or easily startled? 4. In the past month, have you felt numb or detached from people, activities, or your surroundings? 5. In the past month, have you felt guilty or unable to stop blaming yourself or others for the events or any problems the events may have caused?

• Pain as Assessed by Score on the Behavioral Pain Scale (BPS) Hospital discharge (up to 6 weeks post hospital admission)

  BPS score ranges from 3-12, with higher scores indicating worse pain. This assessment is used in non-verbal participants.

• Pain as Assessed by Average Score on the Defense and Veterans Pain Rating Scale (DVPRS) From time of admission to time of discharge from hospital (about 1 to 6 weeks after admission)

  DVPRS scores were collected daily. For each participant, an average of the daily scores on the Defense and Veterans Pain Rating Scale was calculated. DVPRS scores range from 0 (no pain) to 10 (as bad as it could be, nothing else matters), with a higher score indicating a worse outcome.