Pain medication administration in pediatric trauma patients with long bone fractures before emergency department arrival

Abstract

Study objectives: We review the frequency with which pain medications are given in the field to alert pediatric trauma patients with long bone fractures and no apparent contraindications and determine the time to first pain medication administration in this group after emergency department (ED) arrival. Methods: This was a retrospective medical record review involving all pediatric trauma patients diagnosed at our Level I trauma center with 1 or more long bone fractures from January 1998 through August 2002. All nonintubated patients younger than 16 years and with a Glasgow Coma Scale score of 15 were included in the search. Demographics; allergies; out-of-hospital times, vital signs, and pain medication use; pain scores on ED arrival; and time to first pain medication in the ED were all extracted from the records by a single trained abstracter using a structured data collection form. Descriptive statistics were used to evaluate the data. Results: Of the 1,200 patients in the pediatric trauma registry, 55 met the specified search criteria and were included for evaluation. Four patients were not transported by emergency medical services, and 3 additional patients had incomplete data, necessitating their exclusion from analysis, which left a final sample size of 48 patients. The average age was 9.4 years, and 70% were male patients. All but 1 of the fractures involved the lower extremities. None of the children had a documented allergy to analgesics. The mean shock index was 0.9, with all but 2 patients having normal age-appropriate vital signs. The average transport time from the scene was 14 minutes (95% confidence interval [CI] 10 to 18 minutes). Four of 48 patients (8%; 95% CI 2% to 20%) received pain medications, with all 4 getting morphine. The median pain score on ED arrival on a 5-point scale was 4.5 (range 2 to 5), and the mean time from arrival to first dose of pain medication was 25 minutes (95% CI 18 to 31 minutes). Conclusion: Few pediatric trauma patients who had long bone fractures and were transported to the ED by ambulance were given pain medication in the field, and there was a substantial delay to pain medication after ED arrival. Future research will focus on what occurrence is appropriate, what barriers to adequate pain relief exist, and how to overcome them to improve pain management in the out-of-hospital setting.