Prehospital Analgesic Administration by Parents for Pain Relief in Children

Undertreatment of pain by caregivers before presentation to the pediatric emergency department (ED) has been well documented. What has yet to be elucidated are the reasons why caregivers fail to adequately treat pain before arrival in the ED and whether there are differences based on ethnic background or age of the child. The objectives of this study were to determine the barriers to giving pain medication for injuries before ED arrival and to determine if there are any ethnic- or age-related variations to giving pain relief at home.

This prospective descriptive study was conducted in the ED at a tertiary care, freestanding children's hospital with a current annual census of approximately 80,000. An anonymous prospective questionnaire was given to caregivers of children between 2 and 17 years of age presenting to the ED between August 2013 and September, 2014. The study population was obtained as a convenience sample. All were self-referred with chief complaints of head, ear, or extremity pain. The questionnaire asked about pain medications and doses given at home as well as the reasons parents gave medication or refused to give pain medication before arrival. Charts were then abstracted to obtain demographic information and care received in the ED.

A total of 154 (45.6%) of the 338 patients enrolled did not receive pain relief before coming to the ED. There were no differences in pain medication received at home based on ethnicity (P = 0.423) or age (P = 0.580). Parents could choose from a list of multiple reasons as to why pain medications were given and/or free text their own answer. The main reasons given by parents were that the accident did not happen at home (28.6%) and that they did not have time to give pain relief before coming to the ED (13%). Other common answers were "had no pain relievers at home" (12.4%) or "afraid it would be wrong/harmful/did not want to mask symptoms" (9.2%). Seventeen parents responded that their child did not complain of pain. Overall, only 28.1% of participants stated lack of pain medications at home.

In this study, approximately half of all children receive an analgesic for their painful condition before coming to the ED. Continued education regarding pain relief before coming to the ED is needed. Future studies will focus on educating parents to provide analgesia at home.