Aims Pain is the commonest symptom in the emergency setting. It has previously been described that pre-hospital assessment of pain in children by paramedics is often inadequate and that pain severity is frequently underestimated. To date, there is no published data in Ireland on acute pain management in children, in the emergency setting. This study aims to describe the prevalence of acute pain in children presenting to emergency departments (EDs) in Ireland via ambulance, with reference to severity, aetiology, and efficacy of current pre-hospital analgesic interventions, prior to ED arrival.
Methods A national prospective cross-sectional study was undertaken in 7 EDs over a 12-month period (1st November 2011 – October 31st 2012). Ethical approval was granted for this study. All children (<16 years) who attended the ED via ambulance with pain as a documented symptom during ambulance transfer were included. Patient demographics, cause of pain, vital signs (including pain scores), pre-hospital pain interventions, and initial ED management were recorded.
Results 5,560 children were transported to the 7 EDs by ambulance over the study period. 2,450 (44%) had a documented complaint of pain on the ambulance patient care report form. Injury was implicated in over 2/3’s of cases. 60% were male with a mean age of 8 years (2 months-15 years). 24% of children had their pain formally assessed in the pre-hospital phase of care, of whom 2/3’s were recorded as experiencing acute moderate to severe pain. Younger age was associated with poorest pain management. 45% of children had no documented analgesic intervention prior to ED arrival. On ED arrival, 48% of children had their pain formally documented and 56% were administered analgesia.
Conclusion The assessment and treatment of acute pain in children remains a significant problem in the emergency setting in Ireland. Further studies are required to formally delineate the barriers, as perceived by emergency healthcare providers, to managing acute pain in this vulnerable population. Additionally, alternative strategies must be explored both to augment the timely assessment of pain intensity, particularly in pre-verbal children, and facilitate the effective treatment of moderate to severe pain.
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