Missing triage pain-score documentation and analgesic administration in adult trauma patients

Missing triage pain documentation is often treated as incomplete data, but it may identify a clinically distinct group of trauma patients. We evaluated whether a missing triage activity pain score was associated with analgesic administration in the emergency department among adult trauma patients.

We performed a retrospective cohort study of adult trauma registry encounters at a Level I trauma center from May 1, 2022, through April 30, 2025. The exposure was a missing triage activity pain score. The primary outcome was receipt of any emergency department analgesia. Multivariable logistic regression adjusted for age, sex, Injury Severity Score, trauma activation level, and arrival mode. Modified Poisson regression estimated adjusted risk ratios.

The cohort included 6095 encounters, of which 5706 had linked analgesia outcome data. The primary complete-case model included 4825 encounters. Analgesia was received by 63.3% of patients with documented pain scores and 36.5% with missing scores. Missing pain-score documentation was associated with lower receipt of any analgesia (adjusted odds ratio [aOR] 0.41, 95% CI 0.33-0.51; adjusted risk ratio [aRR] 0.66, 95% CI 0.59-0.74) and opioid analgesia (aOR 0.39, 95% CI 0.30-0.51; aRR 0.50, 95% CI 0.40-0.62); results were similar in multiple-imputation and time-restricted sensitivity analyses.

Missing triage activity pain-score documentation was associated with substantially lower emergency department analgesic receipt among adult trauma patients. The observational design does not establish causation.