Original Contribution
Out-of-hospital emergency medicine in pediatric patients: prevalence and management of pain

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Abstract

Introduction

Much less is known about pain prevalence in pediatric patients in an out-of-hospital than emergency department setting. The purpose of this study was to determine pain prevalence in children in a prehospital emergency setting and to identify the factors associated with pain relief.

Materials and Methods

This prospective cohort study in consecutive patients 15 years or younger was conducted by 5 mobile intensive care units working 24/7 (January-December 2005). The presence of pain, its intensity, and alleviation by the administration of analgesics were recorded.

Results

A total of 258 of 433 pediatric patients were included, of whom 96 were suffering from acute pain (37%; 95% confidence interval [CI], 31-43) that was intense to severe in 67% of cases. Trauma was the only factor significantly associated with acute pain (odds ratio, 818; 95% CI, 153-4376). Overall, 92% of the children in pain received at least one analgesic drug; 41% received a combination of drugs. Opioid administration was significantly associated with intense to severe pain (odds ratio, 7; 95% CI, 2-25). On arrival at hospital, 67% of the children were still in pain; but 84% had experienced some pain relief regardless of their sex, age, or disorder.

Conclusion

In a prehospital emergency setting, more than a third of children experience acute pain with a high prevalence of intense to severe pain. Scoring pain in children, and especially in the newborn, is beleaguered by a lack of suitable scales. Despite this, it was possible to treat 90% of children in pain and provide relief in 80% of cases.

Introduction

Acute pain is a common reason for children being taken to hospital emergency departments (EDs). In a study of children older than 4 years, the prevalence of pain was 69%, with 48% of cases of intense pain, defined by a score of 4/10 or higher with a colored analog scale [1]. The prevalence of pain in out-of-hospital emergency medicine has been studied in adults but, to our knowledge, not in children [2], [3].

Pain management in many patients is often inadequate (oligoanalgesia), despite the availability of consensus guidelines on pain management in emergency medicine, pain being considered as the fifth vital sign [4], [5]. Guidelines stress the need for prompt management of pain during patient transport [5]. However, physicians do not seem to be at ease with pain assessment and its interpretation, particularly in children [6].

The aim of this study was to measure the prevalence of pain in children in prehospital emergency medicine in an urban setting and to identify the factors associated with pain relief.

Section snippets

Study design and setting

This was a prospective cohort study conducted between January 1 and December 31, 2005, by 5 around-the-clock mobile units (Service Mobile d'Urgence et de Réanimation) of the emergency services (Service d'Aide Médical d'Urgence [SAMU 93]) of a large suburb north of Paris (Seine-Saint-Denis; >1 380 000 inhabitants).

In France, medical emergencies are dealt with by the SAMU, which has a single nationwide call number (no. 15). Emergency physicians respond to the call and decide on the type of help

Cohort characteristics

The MICU transported 433 children to hospital. Data could be analyzed for 293 of these children (68%), and 140 were not included because the initial pain was not evaluated. Among these 293 children, 35 (8%) could not be evaluated for pain for the reasons outlined in the flowchart of Fig. 1. The 258 evaluable patients comprised 103 big children (40%), 40 small children (15%), 108 babies (42%), and 6 newborn (2%); 184 (71%) were boys. They were suffering from the following disorders: trauma (n =

Discussion

Our study has shown that pain is a common symptom in children in prehospital emergency medicine. It occurred in 37% of children, was intense to severe in 67% of cases, and was treated in 90% of cases, providing a relief rate of 80%. The prevalence rate was lower than that published for children brought to EDs (69% in 334 children aged ≥4 years) [1]. However, the rate of intense to severe pain was higher (67% vs 48% for a >4/10 score) [1]. This difference is probably explained by the type of

Conclusion

The prevalence of pain in children is high in an out-of-hospital emergency setting. Although the lack of suitable scales, especially for infants, makes pain assessment difficult, pediatric patient management and treatment efficacy were the same across all age groups.

References (17)

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