Pain Treatment in Polish Emergency Medical Teams—Is the Pain Management Entitlement Being Used?—A Retrospective Study

Round 1

Reviewer 1 Report

1. The study design seems cross-sectional based on retrospective medical records rather than retrospective cohort. The authors need to clarify.

2. The post-hoc test needs to modify the type I error 0.05 to 0.05 divided by combination of groups (C k groups to 2) to avoid multiple comparison due to chance alone.

3. I suggest the authors provide the numbers and percentage of each excluded criteria to avoid readers for guess.

4. Up to 794 records was excluded. The authors need to discuss the section bias and generalizability for your findings (539 cases)

5. I suggest to make a table to present Kruskal-Wallis ANOVA test by ranks, and the post-hoc test results.

6. The authors had better provide the strengths and novelty in the text.

Asked English native speakers for proofreading is highly recommended.

Author Response

Dear Reviewer,

Thank you very much for your review and all your suggestions on the manuscript. We have tried to edit it according to your suggestions. Our responses to your comments are attached below.

Your revision has greatly helped to improve the manuscript. 

Yours sincerely,

Authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for the opportunity of reviewing this manuscript. I reviewed this manuscript with great interest, but there are some problems for publication.

First, the Patinet flow is messy. In particular, while the analysis file contains 1333 cases, only 539 cases were included in the final analysis, which is less than half of the total. Certainly, it is necessary to exclude cases that did not meet inclusion criteria, but the number of patients in each category that were excluded is not stated, making the quality of the data unreliable. Therefore, the authors need to be more precise in describing patient flow.

Second, in Table 2, the total number of "traumatic pain" did not match the total number of 180 traumatic cases in "The nature of pain". This is another area where the data is considered unreliable and needs to be checked. In addition, basic information such as age and gender is missing.

None

Author Response

Dear Reviewer,

Thank you very much for your review and all your suggestions on the manuscript. We have tried to edit it according to your suggestions. Our responses to your comments are attached below.

Your revision has greatly helped to improve the manuscript. 

Yours sincerely,

Authors

Author Response File: Author Response.pdf

Reviewer 3 Report

In this retrospective study, the authors analyzed medical records to evaluate pain management by emergency medical services (EMS) in Poland. They examined a sample of 539 records of adult patients treated by EMS for acute, traumatic, or neuropathic pain. The results suggest that intravenous analgesics were administered in 62.5% of cases, with choice of medication dependent on pain type and intensity. The authors conclude that opioid use is increasing for more severe pain, and differences exist between basic and specialist EMS teams. Below please find the major and minor concerns about this study.

Major concerns:

• The introduction does not clearly establish the rationale and objectives for the study. The authors should state the knowledge gaps and specific aims guiding their research.

• The analysis appears disorganized, jumping between many statistical tests without a logical flow. Restructuring this section thematically could enhance readability.

• The discussion provides minimal interpretation of the results. The authors should expand on the meaning and implications of the main findings and limitations.

Minor concerns: 

• More background details in the introduction would help frame the research question and context.

• "S" EMS and "P" EMS in the abstract need to be defined.

• The authors could use more figures and plots to show the data.

• Tables/figures need more informative titles and legends.

• Writing style could be improved throughout for clarity and concision.

In summary, I think this manuscript requires substantial revision to clarify the purpose, improve organization/flow, provide deeper analysis and interpretation, and enhance the scholarly contribution. Addressing the major issues outlined above could strengthen the quality and impact of this work.

In addition to the scientific issues outlined above, the quality of the English language throughout the manuscript requires improvement. There are frequent grammatical errors, awkward phrasing, and unclear sentences that impede readability and precision.

Author Response

Dear Reviewer,

Thank you very much for your review and all your suggestions on the manuscript. We have tried to edit it according to your suggestions. Our responses to your comments are attached below.

Your revision has greatly helped to improve the manuscript. 

Yours sincerely,

Authors

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The authors did not address the multiple compared problems well. I recommend the authors consulted with Statistician.

I recommend the authors asked English native speaker for proofreading.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors responded the reviewer's remarks. Thank you.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

No further comments. 

There are some typos in the manuscript the authors should try to fix.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf