The epidemiology of pain in children treated by paramedics

Objectives: The present study aimed to describe paramedic assessment and management of pain in children in a large state-wide ambulance service. Methods: A retrospective cohort study included paediatric patients (aged less than 15years) treated and transported by paramedics in the Australian state of Victoria between 1 January 2008 and 31 December 2011. Primary outcome measures were the frequency of analgesic administration and odds of receiving any analgesic (morphine, fentanyl or methoxyflurane). Data were analysed by descriptive statistics, χ²-test and logistic regression to test the association between analgesic administration and the explanatory variables. Results: There were 38167 cases that included a description of pain and where any pain scores were >0. Median age was 10years (IQR 5-12), 59.2% were male and 15090 (39.5%) received any analgesic. Of patients reported to have severe pain (verbal numeric rating scale 8-10), only 45% (n=6084) received any analgesia. In unadjusted analysis, patients aged >9years were more likely to receive analgesia than those aged <3years (unadjusted odds ratio 4.39, 95% confidence interval 4.01-4.80). Multiple regression analysis found that significant predictors of analgesic administration were patient's sex, patient age, type of pain, initial pain score and case year. Conclusion: Disparities in analgesic administration based on age and the low rate of pain scores documented in very young children identified in the present study should inform strategies that aim to improve the assessment and management of pain in children.