267 Review of prehospital pain management in pediatric trauma. (1st May 2022)

• Record Type: Journal Article
• Authors: Montero, SI; Villamor, CL; Lara, JA; Corral, E; Miguel, F; Bélanger-Quintana, D
• Is Part Of: BMJ open. Volume 12(2022)Supplement 1
• Page Start: A7
• Page End: A8
• Publication Date: 2022-05-01
• Subjects: Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2022-EMS.17
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Background: Adequate management of pain in children if often a neglected aspect, usually underevaluated and under-treated. This study is a continuous review to see if pharmacological methods provided during the prehospital care of pediatric trauma patients is proper. Method: Retrospective study of clinical records of children up to 18 year of age, assisted between 2017 and 2018. Mild pathologies excluded. Epidemiological variables: age, gender, diagnosis, pediatric trauma score(PTS), analgesia, numeric rate scale(NRS), drugs administered. Quantitative variables: central and dispersión measures. Inferential statistical análisis: relationship quantitative variables, Student's t test and categorical variables, Chi square. 95% confidence intervals, p<0.05. SPSS 20. Results: Total of 725 patients. Median age was 13 years(IQR 8–15). 70.9% males (514). Critically ill patients constitute 5.8% (42). Children received analgesia: 43.6%(316); <4 years: 17.3% (14), 5 to 11: 36.7% (80) and 12 to 18: 52.1% (222). IV route: 70.8% (240), intranasal: 21.4%(74). Fentanyl was used in 73.4% (232), Paracetamol 23.1%(73), Ketorolac 22.8%(72). IV mean doses: 1.9µgr/Kg, 15.1mg/Kg, 0.34mg/Kg respectively. Analgesia with PTS <9: 76.5% and PTS ≥ 9: 42.8%. NRS used in 12.5%(91); median initial: 8(IQR 7–9) and after analgesia: 3(IQR 2–4). Conclusion: IV opioids are the most widely used. Doses administered by weight are correct. The use of analgesia predominates in critically ill patients although not as high as indicated in international guidelines. We observed undertreatment in the groups of younger children, possibly due to a higher incidence of TBI. Alternative routes to IV administration could increase the use. Although pain scales were seldom used, the results show notable reduction of pain. Conflict of interest: None. Funding: None.