Predictors of effective management of acute pain in children within a UK ambulance service: A cross-sectional study - 19/12/19

Doi : 10.1016/j.ajem.2019.11.043

Gregory Adam Whitley, MSc BSc (Hons) ^a,^{^⁎} , Pippa Hemingway, PhD BSc (Hons) ^b, Graham Richard Law, PhD BSc (Hons) ^a, Caitlin Wilson, MSc BSc (Hons) ^c, Aloysius Niroshan Siriwardena, PhD MMedSci ^a
^a Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England, United Kingdom
^b Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, England, United Kingdom
^c North West Ambulance Service NHS Trust, Bolton, England, United Kingdom

^⁎Corresponding author at: Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Sarah Swift Building, Brayford Wharf East, Lincoln LN5 7AT, England, United Kingdom.Community and Health Research UnitSchool of Health and Social CareUniversity of LincolnSarah Swift Building, Brayford Wharf EastLincolnEnglandLN5 7ATUnited Kingdom

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 19 December 2019

Abstract

Objective

We aimed to identify predictors of effective management of acute pain in children in the pre-hospital setting.

Methods

A retrospective cross-sectional study using electronic clinical records from one large UK ambulance service during 01-Oct-2017 to 30-Sep-2018 was performed using multivariable logistic regression. We included all children <18 years suffering acute pain. Children with a Glasgow Coma Scale score of <15, no documented pain or without a second pain score were excluded. The outcome measure was effective pain management (abolition or reduction of pain by ≥2 out of 10 using the numeric pain rating scale, Wong-Baker FACES® scale or FLACC [face, legs, activity, crying and consolability] scale).

Results

2312 patients were included for analysis. Median (IQR) age was 13 (9–16), 54% were male and the cause of pain was trauma in 66% of cases. Predictors of effective pain management include children who were younger (0–5 years) compared to older (12–17 years) (adjusted odds ratio [AOR] 1.53; 95% confidence interval [CI] 1.18–1.97), administered analgesia (AOR 2.26; CI 1.87–2.73), attended by a paramedic (AOR 1.46; CI 1.19–1.79) or living in an area of low deprivation (index of multiple deprivation [IMD] 8–10) compared to children in an area of high deprivation (IMD 1–3) (AOR 1.37; CI 1.04–1.80). Child sex, type of pain, transport time, non-pharmacological treatments and clinician experience were not significant.

Conclusion

These predictors highlight disparity in effective pre-hospital management of acute pain in children. Qualitative research is needed to help explain these findings.

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Keywords : Emergency medical services, Ambulances, Infant, Child, Adolescent, Pain