title: Prehospital Opioid Administration in the Emergency Care of Injured Children.
abstract: OBJECTIVE
  Prior studies have identified provider and system characteristics that impede pain management in children, but no studies have investigated the effect of changing these characteristics on prehospital opioid analgesia. Our objectives were to determine: 1) the frequency of opioid analgesia and pain score documentation among prehospital pediatric patients after system wide changes to improve pain treatment, and 2) if older age, longer transport times, the presence of vascular access and pain score documentation were associated with increased prehospital administration of opioid analgesia in children.
  
  
  METHODS
  This was a retrospective cross-sectional study of pediatric patients aged 3-18 years assessed by a single EMS system between October 1, 2011 and September 30, 2013. Prior to October 2011, the EMS system had implemented 3 changes to improve pain treatment: (1) training on age appropriate pain scales, (2) protocol changes to allow opioid analgesia without contacting medical control, and (3) the introduction of intranasal fentanyl. All patients with working assessments of blunt, penetrating, lacerating, and/or burn trauma were included. We used descriptive statistics to determine the frequency of pain score documentation and opioid analgesia administration and logistic regression to determine the association of age, transport time, and the presence of intravenous access with opioid analgesia administration.
  
  
  RESULTS
  Of the 1,368 eligible children, 336 (25%) had a documented pain score. Eleven percent (130/1204) of children without documented contraindications to opioid administration received opioids. Of the children with no documented pain score and no protocol exclusions, 9% (81/929) received opioid analgesia, whereas 18% (49/275) with a documented pain score ≥4 and no protocol exclusions received opioids. Multivariate analysis revealed that vascular access (OR = 11.89; 95% CI: 7.33-19.29), longer patient transport time (OR = 1.07; 95% CI: 1.04-1.11), age (OR 0.93; 95% CI: 0.88-0.98) and pain score documentation (OR 2.23; 95% CI: 1.40-3.55) were associated with opioid analgesia.
  
  
  CONCLUSIONS
  Despite implementation of several best practice recommendations to improve prehospital pain treatment, few children have a documented pain score and even fewer receive opioid analgesia. Children with longer transport times, successful IV placement, and/or documentation of pain score(s) were more likely to receive prehospital analgesia.
authors.forename: Lorin R
authors.initials: LR
authors.lastname: Browne
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Studnek
authors.forename: Manish I
authors.initials: MI
authors.lastname: Shah
authors.forename: David C
authors.initials: DC
authors.lastname: Brousseau
authors.forename: Clare E
authors.initials: CE
authors.lastname: Guse
authors.forename: E Brooke
authors.initials: EB
authors.lastname: Lerner
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004282:Documentation; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D012189:Retrospective Studies; D014922:Wisconsin; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D000701:Analgesics, Opioid
keywords: pain score; pediatric pain; prehospital opioid analgesia