M I Harris1, K M Adelgais2, S W Linakis3, C F Magill4, R Brazauskas5, M I Shah6, D K Nishijima7, G S Lowe8, K Chadha9, T P Chang10, E B Lerner9, J C Leonard3, H P Schwartz11, J B Gaither12, J R Studnek13, L R Browne14,15. 1. Department of Pediatrics, Northwell Hofstra School of Medicine, New Hyde Park, New York. 2. Department of Pediatrics, University of Colorado, Aurora, Colorado. 3. Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio. 4. Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina. 5. Department of Institute for Health Equity, Medical College of Wisconsin, Milwaukee, Wisconsin. 6. Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas. 7. Department of Emergency Medicine, University of California - Davis, Sacramento, California. 8. Department of Pediatrics, University of Texas Southwestern, Dallas, Texas. 9. Department of Emergency Medicine, University at Buffalo, Buffalo, New York. 10. Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, California. 11. Division of Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. 12. Department of Emergency Medicine, University of Arizona, Tucson, Arizona. 13. Mecklenburg EMS Agency, Charlotte, North Carolina. 14. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin. 15. Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Abstract
OBJECTIVE: Provision of analgesia for injured children is challenging for Emergency Medical Services (EMS) clinicians. Little is known about the effect of prehospital analgesia on emergency department (ED) care. We aimed to determine the impact of prehospital pain interventions on initial ED pain scale scores, timing and dosing of ED analgesia for injured patients transported by EMS. METHODS: This is a planned, secondary analysis of a prospective multicenter cohort of children with actual or suspected injuries transported to one of 11 PECARN-affiliated EDs from July 2019-April 2020. Using Wilcoxon rank sum for continuous variables and chi-square testing for categorical variables, we compared the change in EMS-to-ED pain scores and timing and dosing of ED-administered opioid analgesia in those who did and those who did not receive prehospital pain interventions. RESULTS: We enrolled 474 children with complete prehospital and ED pain management data. Prehospital interventions were performed on 262/474 (55%) of injured children and a total of 88 patients (19%) received prehospital opioids. Children who received prehospital opioids with or without adjunctive non-pharmacologic pain management experienced a greater reduction in pain severity and were more likely to receive ED opioids in higher doses earlier and throughout their ED care. Non-pharmacologic pain interventions alone did not impact ED care. CONCLUSIONS: We demonstrate that prehospital opioid analgesia is associated with both a significant reduction in pain severity at ED arrival and the administration of higher doses of opioid analgesia earlier and throughout ED care.
OBJECTIVE: Provision of analgesia for injured children is challenging for Emergency Medical Services (EMS) clinicians. Little is known about the effect of prehospital analgesia on emergency department (ED) care. We aimed to determine the impact of prehospital pain interventions on initial ED pain scale scores, timing and dosing of ED analgesia for injured patients transported by EMS. METHODS: This is a planned, secondary analysis of a prospective multicenter cohort of children with actual or suspected injuries transported to one of 11 PECARN-affiliated EDs from July 2019-April 2020. Using Wilcoxon rank sum for continuous variables and chi-square testing for categorical variables, we compared the change in EMS-to-ED pain scores and timing and dosing of ED-administered opioid analgesia in those who did and those who did not receive prehospital pain interventions. RESULTS: We enrolled 474 children with complete prehospital and ED pain management data. Prehospital interventions were performed on 262/474 (55%) of injured children and a total of 88 patients (19%) received prehospital opioids. Children who received prehospital opioids with or without adjunctive non-pharmacologic pain management experienced a greater reduction in pain severity and were more likely to receive ED opioids in higher doses earlier and throughout their ED care. Non-pharmacologic pain interventions alone did not impact ED care. CONCLUSIONS: We demonstrate that prehospital opioid analgesia is associated with both a significant reduction in pain severity at ED arrival and the administration of higher doses of opioid analgesia earlier and throughout ED care.