Prehospital pain assessment in pediatric trauma

Objective. Investigators implemented the current study to analyze the documentation of pain assessments and interventions for injured children in prehospital settings. Methods. For this institutional review board-approved retrospective study, 696 Lucas County Emergency Medical Services trauma charts (46% of the county's total runs) from 2002 to 2004 were reviewed, and descriptive statistics of frequency were used to analyze pain-assessment documentation and interventions. Results. Pain was noted in 64.1% (446/696) of subjects, a statement of "no pain" was noted in 17.2% (120/696) of subjects, and pain was undocumented in 18.7%. Only one trauma chart (1/696, 0.2%) indicated the appropriate use of a validated pain assessment tool (Verbal Rating Scale). There were no documented pain interventions provided to 86.6% (603/696) of all subjects, including 85.0% (379/446) with documented pain. Of all subjects, 13.4% (93/696) received pain interventions. Pharmacological interventions were used for 2.2% (15/696) of all subjects and 16.1% (15/93) of subjects with documented pain interventions. Nonpharmacologic interventions were used in 12.4% of cases (86/696), in which traction and splinting were the most common interventions (36/93,38.7%), followed by saline flush with dressing (15/93, 16.1%). Diversion and distraction techniques were documented in five charts in which a pain intervention was documented (5/93, 5.4%). Conclusions. These results identify a void in the documentation of pain assessment and implementation of pain-control interventions for injured pediatric patients. Education for prehospital providers is recommended, emphasizing the importance of pain assessment and documentation of pain-control care for pediatric trauma patients.