Out-of-hospital emergency medicine in pediatric patients: prevalence and management of pain.
BACKGROUND
Much less is known about pain prevalence in pediatric patients in an out-of-hospital than emergency department setting. The purpose of this study was to determine pain prevalence in children in a prehospital emergency setting and to identify the factors associated with pain relief.


METHODS
This prospective cohort study in consecutive patients 15 years or younger was conducted by 5 mobile intensive care units working 24/7 (January-December 2005). The presence of pain, its intensity, and alleviation by the administration of analgesics were recorded.


RESULTS
A total of 258 of 433 pediatric patients were included, of whom 96 were suffering from acute pain (37%; 95% confidence interval [CI], 31-43) that was intense to severe in 67% of cases. Trauma was the only factor significantly associated with acute pain (odds ratio, 818; 95% CI, 153-4376). Overall, 92% of the children in pain received at least one analgesic drug; 41% received a combination of drugs. Opioid administration was significantly associated with intense to severe pain (odds ratio, 7; 95% CI, 2-25). On arrival at hospital, 67% of the children were still in pain; but 84% had experienced some pain relief regardless of their sex, age, or disorder.


CONCLUSIONS
In a prehospital emergency setting, more than a third of children experience acute pain with a high prevalence of intense to severe pain. Scoring pain in children, and especially in the newborn, is beleaguered by a lack of suitable scales. Despite this, it was possible to treat 90% of children in pain and provide relief in 80% of cases.
Galinski
Michel
M
Centre National de Ressource de Lutte contre la douleur, Hôpital trousseau, Paris, France.
Picco
Naddège
N
Hennequin
Brigitte
B
Raphael
Valérie
V
Ayachi
Azzédine
A
Beruben
Arielle
A
Lapostolle
Frédéric
F
Adnet
Frédéric
F
D000293:Adolescent; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement; D015995:Prevalence; D011446:Prospective Studies
D000700:Analgesics