Does current pre-hospital analgesia effectively reduce pain in children caused by trauma, within a UK ambulance service? A service evaluation

Introduction ‐ Pain is one of the most common symptoms presented by patients of all ages to ambulance services, however very few children receive analgesia. Analgesic treatment of pre-hospital injured children is viewed as ‘suboptimal’. The aim of this study was to explore current analgesia given to traumatically injured children in the pre-hospital setting and examine whether a clinically meaningful reduction in pain was achieved.

Methods ‐ We evaluated electronic patient report forms over a two-year period (2013‐2014) within a UK ambulance service NHS trust. All traumatically injured children within the age range 1‐17 with a clinical impression of a fracture, dislocation, wound or burn were included. Patients with a Glasgow Coma Scale of < 15 were excluded. The outcome measure was a reduction in numeric pain rating scale or Wong and Baker faces of ≥ 2 out of 10.

Results ‐ Of the evaluable patients (N = 11,317), 90.8% had a documented pain score, or a reason why a pain score could not be documented. For patients reporting pain (N = 7483), 51.6% (n = 3861) received analgesia, 9.6% (n = 717) received no analgesia but did receive alternative treatment and 38.8% (n = 2905) received no analgesia and no alternative treatment. Morphine sulphate IV, oral morphine, Entonox, paracetamol suspension and poly-analgesia all achieved a clinically meaningful median reduction in pain score; ‐3.0 (IQR, ‐5.0 to ‐2.0), ‐2.0 (‐5.0 to ‐2.0), ‐2.0 (‐4.0 to ‐1.0), ‐2.0 (‐4.0 to 0.0) and ‐3.0 (‐4.0 to ‐1.0), respectively.

Conclusions ‐ Analgesia administered to traumatically injured children in the pre-hospital setting within this UK ambulance service NHS trust produces clinically meaningful reductions in pain for these patients. The concern is that a large number of patients received neither analgesia nor alternative treatment. There is a real need to identify barriers to analgesia administration in this patient group.