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

Aim

Analgesic treatment of pre-hospital injured children is viewed as 'suboptimal' with few receiving analgesia. 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 and 2014) within a UK ambulance service NHS trust. All traumatically injured children within the age range of 1 to 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=7,483), 51.6% (n=3,861) received analgesia, 9.6% (n=717) received no analgesia but did receive alternative treatment and 38.8% (n=2,905) 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.

Conclusion

Analgesia administered to traumatically injured children in the pre-hospital setting within this UK ambulance service NHS trust does produce clinically meaningful reductions in pain. The concern is that a large number of patients received no analgesia or alternative treatment. There is a real need to identify barriers to analgesia administration in this patient group.

Conflict of interest

None declared.

Funding

None declared.

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