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Analgesic Pain Management of Pediatric Trauma Patients Reporting Severe Pain

Author: Jarrod Plumley | |

Associate Authors: Amanda Armstrong | Emily A. Burchette | Paige Grillo | Melisa Martin

Introduction

In the prehospital setting, pain management remains a concern. There are limited studies that evaluate this in the prehospital setting. Hospital-based studies demonstrate mixed reviews in pain medication administration rates by age, gender, pain scale, and minority status. It is possible that prehospital providers fail to administer pain medication to pediatric patients or administration may vary by age, gender, or minority status.

Objectives

To evaluate pain management in unimpaired, hemodynamically stable, pediatric trauma patients reporting severe pain.

Methods

A retrospective analysis was conducted using pediatric (< 18 years of age) data from ESO solutions national database
from January 1, 2017 to December 31, 2017. Inclusionary criteria consisted of patients with GCS ≥ 13, complaint of
trauma, highest reported pain score ≥ 8, who were hemodynamically stable. Hemodynamic stability was determined by age appropriate blood pressure as described by US Department of Health and Human Services. Analgesics included were dilaudid, demerol, fentanyl, ketamine, and morphine. Logistic regression was used to calculate an adjusted odds ratio (OR) for factors (age, gender, minority status, and pain scale) associated with the administration of analgesia.

Results

A total of 8126 patients were included, of which 3329 (37.8%) received pain medication. The sample was largely White males (60.3%, N = 5,318) with an average age of 13.42 (±SD = 4.19) years. For every year of age, patients were more likely to receive pain medication (OR = 1.04, P < 0.01). Compared to males, females were less likely to receive pain medication (OR = 0.56, P < 0.01); and non-Whites were less likely to receive pain medications compared to Whites (OR = 0.56, P < 0.01). Each additional increase in numeric pain rating resulted in 76% (OR = 1.76, P < 0.01) increase in likelihood of analgesia administration.

Conclusion

Despite indications, the majority of patients (63.4%) did not receive pain medication. The study identified disparity in the treatment of prehospital pediatric trauma patients who reported severe pain, filtered by age, gender, minority status, and pain scale. Further study is needed to identify why patients did not receive pain medications.