Am J Emerg Med. 2010 Aug 2. [Epub ahead of print]
Out-of-hospital emergency medicine in pediatric patients: prevalence and management of pain.
Galinski M, Picco N, Hennequin B, Raphael V, Ayachi A, Beruben A, Lapostolle F, Adnet F.
Abstract
INTRODUCTION: Much less is known about pain prevalence in pediatric patients in an out-of-hospital than emergency department setting. The purpose of this study was to determine pain prevalence in children in a prehospital emergency setting and to identify the factors associated with pain relief. MATERIALS AND METHODS: This prospective cohort study in consecutive patients 15 years or younger was conducted by 5 mobile intensive care units working 24/7 (January-December 2005). The presence of pain, its intensity, and alleviation by the administration of analgesics were recorded. RESULTS: A total of 258 of 433 pediatric patients were included, of whom 96 were suffering from acute pain (37%; 95% confidence interval [CI], 31-43) that was intense to severe in 67% of cases. Trauma was the only factor significantly associated with acute pain (odds ratio, 818; 95% CI, 153-4376). Overall, 92% of the children in pain received at least one analgesic drug; 41% received a combination of drugs. Opioid administration was significantly associated with intense to severe pain (odds ratio, 7; 95% CI, 2-25). On arrival at hospital, 67% of the children were still in pain; but 84% had experienced some pain relief regardless of their sex, age, or disorder. CONCLUSION: In a prehospital emergency setting, more than a third of children experience acute pain with a high prevalence of intense to severe pain. Scoring pain in children, and especially in the newborn, is beleaguered by a lack of suitable scales. Despite this, it was possible to treat 90% of children in pain and provide relief in 80% of cases.If we could only get these numbers with our adult patients. I can't help but believe this is due to a couple main factors. 1. We inherently want to make kids feel better & 2. We are pretty sure that our pediatric patients aren't drug seekers.
Here is some advice, treat adult patience that have pain as if they were pediatric patients that have pain. Just make sure you adjust the dose proportionately. This is not an attempt to be cynical, yet just the opposite. I am attempting to remove all cynical notions preventing appropriate pain management.
The sad part about this is that most of the time we know we can, but even when we call for the orders we never get them. It discourages us from asking, so we never do as good a job as we know we can do.
ReplyDeleteHybridMedic,
ReplyDeleteI think that is the problem with systems like that. Standing orders for pain management should be a standard. I'm lucky I don't have to deal with that I guess. It is also important that some pain management begins with BLS procedures, like an ice pack. Of coarse that only works for muscoskeletal pain, but it is something to think about. Don't get discouraged though. If it is your protocol to call for orders, then call for orders; every time you want to treat the pain. Make a good case, and sound confident. They can't get mad at you for following your protocol. And if they do, it really just labels the type of clinician that they are.
Demand progression.
Thanks for your comment.
Recently our medical control has been replying, when we ask for pain control orders, with "you have a protocol for pain control, right?" It has been nice being freed up to treat pain in more clinical situations!
ReplyDeleteOdd, because it seems like most providers in my area are scared of kids in general, and terrified of medicating them.
ReplyDeleteI am actually surprised at this study for both pre-hospital and emergency department settings. Pediatric pain in non-peds settings is actually not well treated and the younger the child the less likely they are to receive pain medicine. I am however encouraged that they were so well treated and also agree that adult patients deserve the same level of care. The cynical side of emergency services assumes all patients are 'seeking' when in fact most patients have some sort of pain and we can do a lot better in treating it.
ReplyDeleteCompletely agree BFN. I was shocked to read the results of this study at first as well. I wonder of the in-hospital data is similar.
ReplyDeleteOn the other hand, some other studies suggest other barriers to pain management. From "Prehospital pain management: a comparison of providers' perceptions and practices."
ReplyDelete"In our study, 81% of the survey responders listed possible drug seeking as a reason for providing no analgesia to adult patients. More interesting was the fact that 65% of the EMT-Ps echoed their fear of drug seeking as a reason for providing no analgesia to children."
http://www.ncbi.nlm.nih.gov/pubmed/16036825
Thought-provoking results.