Original ContributionOut-of-hospital emergency medicine in pediatric patients: prevalence and management of pain
Introduction
Acute pain is a common reason for children being taken to hospital emergency departments (EDs). In a study of children older than 4 years, the prevalence of pain was 69%, with 48% of cases of intense pain, defined by a score of 4/10 or higher with a colored analog scale [1]. The prevalence of pain in out-of-hospital emergency medicine has been studied in adults but, to our knowledge, not in children [2], [3].
Pain management in many patients is often inadequate (oligoanalgesia), despite the availability of consensus guidelines on pain management in emergency medicine, pain being considered as the fifth vital sign [4], [5]. Guidelines stress the need for prompt management of pain during patient transport [5]. However, physicians do not seem to be at ease with pain assessment and its interpretation, particularly in children [6].
The aim of this study was to measure the prevalence of pain in children in prehospital emergency medicine in an urban setting and to identify the factors associated with pain relief.
Section snippets
Study design and setting
This was a prospective cohort study conducted between January 1 and December 31, 2005, by 5 around-the-clock mobile units (Service Mobile d'Urgence et de Réanimation) of the emergency services (Service d'Aide Médical d'Urgence [SAMU 93]) of a large suburb north of Paris (Seine-Saint-Denis; >1 380 000 inhabitants).
In France, medical emergencies are dealt with by the SAMU, which has a single nationwide call number (no. 15). Emergency physicians respond to the call and decide on the type of help
Cohort characteristics
The MICU transported 433 children to hospital. Data could be analyzed for 293 of these children (68%), and 140 were not included because the initial pain was not evaluated. Among these 293 children, 35 (8%) could not be evaluated for pain for the reasons outlined in the flowchart of Fig. 1. The 258 evaluable patients comprised 103 big children (40%), 40 small children (15%), 108 babies (42%), and 6 newborn (2%); 184 (71%) were boys. They were suffering from the following disorders: trauma (n =
Discussion
Our study has shown that pain is a common symptom in children in prehospital emergency medicine. It occurred in 37% of children, was intense to severe in 67% of cases, and was treated in 90% of cases, providing a relief rate of 80%. The prevalence rate was lower than that published for children brought to EDs (69% in 334 children aged ≥4 years) [1]. However, the rate of intense to severe pain was higher (67% vs 48% for a >4/10 score) [1]. This difference is probably explained by the type of
Conclusion
The prevalence of pain in children is high in an out-of-hospital emergency setting. Although the lack of suitable scales, especially for infants, makes pain assessment difficult, pediatric patient management and treatment efficacy were the same across all age groups.
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Comparison of Professionally and Parentally Administered Analgesia Before Emergency Department Admission
2023, Pain Management NursingNurses’ experiences of prehospital care encounters with children in pain
2019, International Emergency NursingCitation Excerpt :Ljungman et al. [21] found that intranasal pain relief led to less concern about minor procedures, such as PVC insertion, making the entire experience easier for children, parents, and nurses. Galinski et al. [20] found that pain relief such as nasal administration may increase the use of prehospital pain treatment. According to Murphy et al. [22], intranasal administration for children can increase the effects of pain treatment because it quickly and easily alleviates pain.
Current concepts in management of pain in children in the emergency department
2016, The LancetCitation Excerpt :Musculoskeletal injuries are common;7–9 27–42% of children sustain a fracture before the age of 16 years.10,11 Other common causes include headache, otalgia, sore throat, and abdominal distress.7,12–14 About half of patients report their pain as moderate to severe.7,15,16
Prehospital pain management of injured children: A systematic review of current evidence
2015, American Journal of Emergency MedicineCitation Excerpt :Peripheral nerve block was also selectively used [27]. Galinski et al [15] reported a strikingly higher administration rate of analgesia (92%). This could be attributable to the fact that EMS units participating in this study were mobile intensive care units staffed by physicians.