A Systematic Review of Pain Assessment Tools in Prehospital Emergency Care: Evidence from Observational Studies.

Background: In the prehospital setting, pain assessment and documentation are often insufficient due to time constraints and high workload. Although validated tools such as the Numerical Rating Scale (NRS), Visual Analogue Scale (VAS), and Verbal Rating Scale (VRS) exist for rapid pain assessment, their use in emergency medical services (EMS) remains unclear. Methods: This systematic review was conducted according to the PRISMA 2020 guidelines. A comprehensive search of PubMed, Web of Science, Scopus, and Google Scholar databases was performed for observational studies conducted in prehospital emergency settings, including both trauma and mixed patient populations reporting pain assessment practices. Results: Of the 1,834 identified articles, 8 studies in which pain intensity was measured using standard instruments such as NRS, VAS, or VRS were eligible for inclusion. The results showed that the documentation and assessment of pain in the prehospital setting were performed in only 22.5% to 46.7% of patients, indicating a generally low frequency of pain evaluation before hospital admission. Across the included observational studies, EMS-related pain management interventions were reported to be associated with reductions in pain intensity; however, due to methodological heterogeneity and the absence of quantitative synthesis, the magnitude of these changes could not be reliably estimated. Conclusion: Pain recording and assessment in the prehospital setting are below recommended standards, and only a limited proportion of patients are systematically monitored. This deficiency can lead to inadequate decision-making in pain management. Strengthening the training of EMS personnel for recording pain is essential to improve the quality of care.