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Pain Assessment and Management in Pediatric Trauma Patients Transported to an Emergency Department: A Retrospective
Kaja Kubiak1, Tomasz Konieczny1, Mateusz Henryk Kopczyński1
1Student Research Association of Pediatric Emergency Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland.
Insights
Pediatric trauma patients often experience undertreated pain, with current Emergency Medical Services (EMS) practices falling short of national guidelines for pain assessment and management. Improved documentation and education are crucial for better pediatric pain control.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Trauma Care
Background:
- Effective pain management in pediatric trauma is critical for patient outcomes.
- National guidelines exist for prehospital pediatric pain management, but adherence is often suboptimal.
- Emergency Medical Services (EMS) play a vital role in initial pain assessment and treatment.
Purpose of the Study:
- To assess pain assessment and treatment frequency in pediatric trauma patients transported by EMS.
- To compare current EMS practices against Polish national recommendations for pediatric pain management.
- To identify gaps in prehospital pain management for pediatric trauma.
Main Methods:
- Retrospective analysis of EMS and ED documentation for pediatric trauma patients (<18 years).
- Inclusion of 981 patients with injury, suspected injury, or burns.
- Evaluation of pain assessment, intensity, analgesic administration, non-pharmacological interventions, and reassessment against national guidelines.
Main Results:
- Pain was assessed in 85.5% of patients, with 77.6% reporting moderate pain.
- Only 21.2% received prehospital analgesics; morphine and paracetamol were most common.
- Pain reassessment occurred in 87.5%, but only 29.4% achieved recommended pain reduction; 70.2% lacked guideline-compliant treatment.
Conclusions:
- Pediatric trauma pain is frequently undertreated in prehospital settings.
- Adherence to national guidelines for analgesia and pain reassessment is suboptimal.
- Improvements needed in documentation, pharmacological options for mild pain, and EMS education on guideline-concordant care.
Objectives:
To evaluate how often pain is assessed and treated in pediatric trauma patients transported by Emergency Medical Services (EMS) to a pediatric emergency department (ED), and to compare current practice with national recommendations of the Polish Ministry of Health for prehospital pediatric pain management.
Methods:
We conducted a retrospective analysis of EMS and ED documentation for all trauma patients under 18 years of age transported to the Pediatric Teaching Hospital of the University Clinical Center of the Medical University of Warsaw between 1 January and 31 December 2021. A total of 981 patients with injury or suspected injury or burns were included without exclusion criteria. For patients with documented pain scores, we analyzed pain intensity (0-10), the scales used [Visual Analog Scale (VAS), Numerical Rating Scale (NRS), Wong-Baker Faces Pain Rating Scale (FACES)], body region injured, Glasgow Coma Scale (GCS) score, suspected alcohol or psychoactive substance use, and type and route of analgesic administration. We further evaluated non-pharmacological interventions, pain reassessment, and achievement of at least 50% pain reduction, as defined in national guidelines. Statistical analysis included Student's t-test or ANOVA for quantitative variables and maximum likelihood chi-square tests for qualitative variables (α = 0.05).
Results:
Pain was assessed in 839/981 (85.5%) patients; 651/839 (77.6%) reported pain, most frequently of moderate intensity. Despite this, only 208/981 (21.2%) patients received analgesics prehospitally. Morphine and paracetamol were the most frequently used drugs, predominantly administered intravenously, while non-opioid monotherapy was commonly used in patients with lower baseline pain scores. Less than half of all patients received any non-pharmacological intervention whatsoever. Pain was reassessed in 734/839 (87.5%) patients, with a mean reassessment time of approximately 10 min; however, in many cases reassessment occurred earlier than the expected onset of analgesic action. Overall, only 29.4% of patients with pain and documented reassessment achieved the recommended ≥50% reduction in pain intensity, and at least 70.2% of the cohort had no documented evidence of treatment fully complying with national recommendations.
Conclusions:
In this real-world prehospital and ED cohort, pediatric trauma pain remains under-treated, and adherence to national guidelines on opioid-based analgesia and pain reassessment is suboptimal. Further efforts are needed to improve documentation, expand the recommended pharmacological options for mild pain, and strengthen education on guideline-concordant pediatric pain management in EMS.
