title: Analgesia in the management of paediatric and adolescent trauma during the resuscitative phase: the role of the pediatric trauma centre.
abstract: BACKGROUND
  The objective of this study was to evaluate the use of analgesia in the resuscitative phase of severely injured children and adolescents.
  
  
  METHODS
  A retrospective cohort of paediatric (age<18 years), severely injured (ISS≥12) patients were identified from the London Health Sciences Centre's Trauma Registry from 2007 to 2010. Variables were compared between Analgesia and Non-analgesia groups with Pearson Chi-square and Mann-Whitney U tests. Resuscitative analgesia use was assessed through multivariable logistic regression controlling for age, gender, mechanism, arrival and Trauma Team Activation (TTA).
  
  
  RESULTS
  Analgesia was used in 32% of cases. Univariate analysis did not reveal any differences in gender, age, injury type, injury profile and arrival patterns. Significant differences were found with analgesia used more frequently in patients injured in a motor vehicle collision (58% vs. 42%, p=0.026) and having parents in the resuscitation room (17% vs. 6%, p=0.01). Analgesia patients were more injured (median ISS 22 vs. 17, p=0.027) and had 2.25 times more TTA (39% vs. 17%). Logistic regression revealed patients arriving directly to a trauma centre had a higher incidence of receiving analgesia (OR 2.01, 95% CI: 1.03-3.93), as did TTA (OR 2.18, 95% CI: 1.01-4.73) and having parents in resuscitation room (3.56, 95% CI: 1.23-10.33). Narcotics were most commonly used (85%), followed by benzodiazepines (16%), with 66% given during the primary survey.
  
  
  CONCLUSIONS
  Use of analgesia is important in the acute management of paediatric trauma. Direct presentation to a level I trauma centre, TTA and the presence of parents lead to higher appropriate use of analgesia in paediatric trauma resuscitation.
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada.
authors.forename: Ram V
authors.initials: RV
authors.lastname: Anantha
authors.affiliation: Trauma Program, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Tanya Charyk
authors.initials: TC
authors.lastname: Stewart
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada.
authors.forename: Aarthi
authors.initials: A
authors.lastname: Rajagopalan
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada.
authors.forename: Jillian
authors.initials: J
authors.lastname: Walsh
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada; Trauma Program, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada. Electronic address: neil.merritt@lhsc.on.ca.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Merritt
mesh_terms: D000293:Adolescent; D000698:Analgesia / Q000379:methods*; D001569:Benzodiazepines / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009294:Narcotics / Q000008:administration & dosage*; D010372:Pediatrics / Q000592:standards*; D012151:Resuscitation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D014193:Trauma Centers; D014218:Triage; D014947:Wounds and Injuries / Q000188:drug therapy* / Q000401:mortality
chemical_list: D009294:Narcotics; D001569:Benzodiazepines
keywords: Analgesia; Outcome study; Paediatric trauma; Primary survey; Trauma Team Activation