The epidemiology of pain in children treated by paramedics

Lord, Bill; Jennings, Paul; Smith, Karen

doi:10.1111/1742-6723.12586

Cited by 26 publications

(49 citation statements)

References 34 publications

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“…Effective pain management consists of pharmacological and non-pharmacological interventions (Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives, 2019). Analgesic administration rates for pre-hospital children suffering from acute pain have been low (Lerner et al, 2014;Lord et al, 2016;Whitley and Bath-Hextall, 2017). For example one Australian study (Lord et al, 2016) found that more than half (55%) of children with severe pain (verbal numeric rating scale 8-10) did not receive any analgesics.…”

Section: Introductionmentioning

confidence: 99%

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

Whitley

Hemingway

Law

et al. 2020

J Child Health Care

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We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: ‘child sex (male)’, ‘child age (younger)’, ‘type of pain (traumatic)’ and ‘analgesic administration’. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child’s experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration: PROSPERO CRD42017058960

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Section: Introductionmentioning

confidence: 99%

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

Whitley

Hemingway

Law

et al. 2020

J Child Health Care

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“…Fewer than half of such patients receive analgesia from paramedics11–13 or within 1 hour of arrival at the ED 14. Younger patients are less likely to have a documented assessment of pain intensity or receive adequate pain medication 11,12,14. Even when analgesia is provided, pediatric patients are frequently under-dosed15 and only a small proportion achieve adequate pain relief 14.…”

Section: Introductionmentioning

confidence: 99%

<p>Low-dose methoxyflurane analgesia in adolescent patients with moderate-to-severe trauma pain: a subgroup analysis of the STOP! study</p>

Hartshorn

Dissmann

Coffey

et al. 2019

JPR

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Introduction The undertreatment of acute pain presents a significant challenge in the Emergency Department. This post hoc subgroup analysis of a previously reported randomized controlled UK study reports the efficacy and safety of low-dose methoxyflurane analgesia in treating adolescent patients with moderate-to-severe trauma pain. Patients and methods Three hundred patients (96 in the adolescent subgroup) aged ≥12 years requiring analgesia for acute trauma pain (pain score of 4–7 on the Numerical Rating Scale) at triage were randomized 1:1 to methoxyflurane (up to 6 mL) or placebo (normal saline), both administered using a Penthrox ® inhaler. The patient could request rescue medication (paracetamol/opioids) at any time. The primary endpoint was the change from baseline in visual analog scale (VAS) pain intensity. Results Mean VAS pain score for the adolescent subgroup at baseline was ~ 61 mm. Adjusted mean change in VAS pain intensity from baseline to 5, 10, 15, and 20 minutes was −24.5, −28.1, −31.6, and −31.7 mm for methoxyflurane and −14.6, −18.8, −19.2, and −23.7 mm for placebo, with a statistically significant treatment effect in favor of methoxyflurane overall across all four time points (−9.9 mm; 95% CI: −17.4, −2.4 mm; P =0.0104). Median time to first pain relief was significantly shorter with methoxyflurane (1 minute) than placebo (3 minutes, P <0.0001). Pain relief was reported within 1–10 inhalations in 95.7% of methoxyflurane-treated patients and 64.6% of placebo-treated patients. Rescue medication was requested by two (4.3%) methoxyflurane-treated patients and three (6.3%) placebo-treated patients. Over 95% of patients, physicians, and nurses rated methoxyflurane treatment as “Excellent”, “Very Good” or “Good” compared with between 64% and 68% for placebo. The incidence of adverse events was higher with methoxyflurane (51%) than placebo (42%), mostly comprising mild/transient dizziness and headache. Conclusion This subgroup analysis shows that low-dose inhaled methoxyflurane is a rapid-acting and effective analgesic in adolescent patients presenting with moderate-to-severe trauma pain. Trial registration Clinicaltrials.gov identifier: NCT01420159, EudraCT number: 2011-000338-12.

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“…Despite pain being a key research priority in paediatric emergency care, 1,2 oligoanalgesia is frequently reported. Studies of children with severe trauma-related pain reveal that fewer than half receive analgesia from paramedics, [3][4][5] or within 1 h of arriving at the emergency department (ED). 6 Many children undergoing painful hospital procedures receive no analgesia, and younger children receive disproportionately less analgesia than school-age counterparts.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of inhaled low-dose methoxyflurane for acute paediatric pain: A systematic review

Hartshorn

Middleton

2018

Trauma

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Introduction: Undertreatment of acute, moderate-to-severe pain in children is common, due in part to barriers to the use of opioids. Low-dose methoxyflurane is an inhaled, non-opioid analgesic widely used in Australia and recently approved in Europe for the emergency relief of acute moderate-to-severe trauma pain in adults. Methods: Using an integrative review framework, we conducted a literature analysis to examine the potential utility of methoxyflurane in children with acute pain. EMBASE Õ , MEDLINE Õ and PubMed were searched (criteria included 'methoxyflurane' 'child*' or 'adolescent' or 'pediatr*' or 'paediatr*') from January 2000 to October 2017, along with internet-based sources to identify relevant grey literature (no predefined search criteria). A series of investigative questions were developed regarding the safety and efficacy of methoxyflurane in this setting and addressed using evidence collated from the identified studies. Results: Of 366 results from the literature searches, 6 clinical trials and observational studies were identified which explored the safety and/or efficacy of inhaled methoxyflurane in individuals < 18 years in either a clinical trial or observational study. All six studies concluded that methoxyflurane provides effective and rapid analgesia for paediatric acute moderate-to-severe pain. Methoxyflurane was well tolerated and associated with good levels of patient/healthcare provider satisfaction in this setting. Conclusions: While large-scale studies are needed to better inform treatment approaches for paediatric use, inhaled methoxyflurane has potential to provide easy to administer, needle-free analgesia with a rapid onset and good safety profile.

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The epidemiology of pain in children treated by paramedics

Abstract: 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.

Cited by 26 publications

References 34 publications

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

<p>Low-dose methoxyflurane analgesia in adolescent patients with moderate-to-severe trauma pain: a subgroup analysis of the STOP! study</p>

Efficacy and safety of inhaled low-dose methoxyflurane for acute paediatric pain: A systematic review

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