Prehospital pain management in children suffering traumatic injury.
Prehospital pain management has become an important emergency medical services (EMS) patient care issue.


OBJECTIVE
To describe the frequency of EMS and emergency department (ED) analgesic administration to injured children; to describe factors associated with the administration of analgesia by EMS; and to assess whether children with lower-extremity fractures receive analgesia as frequently as do adults with similar injuries.


METHODS
This was a retrospective study of children (age < 21 years) who were transported by EMS between January 2000 and June 2002 and had a final hospital diagnosis of extremity fractures or burns. Secondarily, children with lower-extremity fractures were compared with a cohort of EMS-transported adults with similar injuries and transported during the same study period. Receipt of and time of parenteral analgesia were recorded.


RESULTS
Seventy-three children met the inclusion criteria. The mean (range) age of this sample was 12.4 (0.9-21) years, with only four patients aged < 5 years. A majority of the patients were male (49/73, 67.1%) and sustained femur (20/73, 27.4%) or tibia/fibula (26/73, 35.6%) fractures. Few pediatric patients received prehospital analgesia (16/73, 21.9%), while a majority received analgesia in the ED (58/73, 79.4%). Prehospital analgesia was associated with earlier patient treatment than that administered in the ED (22.3 +/- 5.9 min vs. 88.3 +/- 38.2 min). Comparing children (n = 33) with adults (n = 76) with similar lower-extremity fractures, a small insignificant difference was found in the rate of prehospital analgesia between children and adults (7/33, 21.2%, vs. 20/56, 26.3%).


CONCLUSIONS
Few pediatric patients receive prehospital analgesia, although most ultimately received ED analgesia. Few factors were identified that could be associated with EMS oligoanalgesia. No difference was found between children and adults in the rates of EMS analgesia.
Swor
Robert
R
Department of Emergency Medicine, William Beaumont Hospital, A Wayne State University Affiliated Program, Royal Oak, Michigan 48073, USA. raswor@aol.com
McEachin
Christine M
CM
Seguin
Debra
D
Grall
Kristi H
KH
D000293:Adolescent; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use*; D001134:Arm Injuries / Q000175:diagnosis / Q000628:therapy; D002056:Burns / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017723:Drug Utilization Review; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000628:therapy; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010147:Pain Measurement; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000700:Analgesics