title: Clinically meaningful reduction in pain severity in children treated by paramedics: a retrospective cohort study.
abstract: BACKGROUND
  Pediatric pain is a common presenting symptom in the prehospital setting; however, there is a lack of data identifying factors associated with effective pain management in this population. We sought to identify the factors associated with clinically meaningful pain reduction in children.
  
  
  METHODS
  An analysis of electronic patient care records of all patients younger than 15 years presenting with pain to the emergency medical service of Victoria, Australia, over a 4-year period (2008-2011). Data were analyzed using descriptive statistics and multivariate regression to assess predictors of clinically meaningful pain reduction. Clinically meaningful pain reduction was defined as a reduction of 2 or more points on an 11-point scale.
  
  
  RESULTS
  A total of 92378 children were transported, of whom 15016 (16.3%) met the inclusion criteria. The median age was 11 (interquartile range, 9-13) years, and 59.2% were male. Patients older than 9 years were less likely (adjusted odds ratio [AOR], 0.5; 95% confidence interval [CI], 0.4-0.6) and boys were more likely (adjusted odds ratio, 1.1; 95% CI, 1.0-1.3) to have a clinically meaningful reduction in pain. Patients with pain classified as musculoskeletal were more likely to achieve a reduction in pain score of 2 or more when compared with pain due to other medical causes (AOR, 1.7; 95% CI, 1.5-1.9).
  
  
  CONCLUSIONS
  Factors other than the type of analgesia are important determinants of prehospital pain relief and are likely to impact on clinical care and research. Clinical audit and research projects should stratify patients according to patient as well as management factors to maximize service improvement.
authors.affiliation: Department of Community Emergency Health and Paramedic Practice, Monash University, Caulfield East, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: paul.jennings@monash.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Jennings
authors.affiliation: School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.
authors.forename: Bill
authors.initials: B
authors.lastname: Lord
authors.affiliation: Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Discipline-Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000488:Allied Health Personnel; D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000700:Analgesics