• Does current pre-hospital analgesia effectively reduce paediatric pain within a uk ambulance service: a service evaluation

      Whitley, Gregory; Bath-Hextall, Fiona (2017-10)
      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. https://emj.bmj.com/content/34/10/e2.3 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2017-207114.8