Clinically meaningful reduction in pain severity in children treated by paramedics: a retrospective cohort study

Introduction: Pediatric pain is a common presenting symptom in the prehospital setting however there is a lack of data identifying the factors associated with effective pain management in this population. We sought to identify the factors associated with clinically meaningful pain reduction in children. Methods An analysis of electronic patient care records of all patients aged less than 15 years presenting with pain to the emergency medical service (EMS) of Victoria, Australia over a 4 year period (2008-2011). Data was analyzed using descriptive statistics and multivariate regression to assess predictors of clinically meaningful pain reduction. Clinically meaningful pain reduction was defined as a reduction of 2 or more points on an 11 point scale. Results 92,378 children were transported of whom 15,016 (16.3%) met the inclusion criteria. The median age was 11 (IQR 9-13) years and 59.2% were male. Patients aged > 9 years were less likely (AOR 0.5, 95% CI 0.4-0.6) and males were more likely (AOR 1.1, 95% CI1.0-1.3) to have a clinically meaningful reduction in pain. Patients with pain classified as musculoskeletal were more likely to achieve a reduction in pain score of 2 or more when compared with pain due to other medical causes (UOR 1.7, 95% CI 1.5-1.9). Conclusions Factors other than the type of analgesia are important determinants of pre-hospital pain relief and are likely to impact on clinical care and research. Clinical audit and research projects should stratify patients according to patient as well as management factors to maximize service improvement