Timing and Delivery of Pain Medication in a Pediatric Level 1 Trauma Center
Jennifer S McLeod, Cory Criss, Jane F. Riebe-Rodgers, Niki Matusko, *Peter Ehrlich
University of Michigan, Ann Arbor, MI
Background (issue): Few reports address the challenge of balancing pain management, clinical assessment, and resuscitation in pediatric trauma patients. We hypothesize that large variability exists in pain medication delivery following trauma.
Methods: A retrospective review was conducted for pediatric patients (<18). Descriptive statistics and regression analysis were used to examine impact of age, ISS, pain score (PS), and delivery of first (T1) and second (T2) pain medication doses.
Findings: One hundred and thirty-seven patients were reviewed. Average age was 9.47 years + 5.42 and ISS 10.55 + 9.01. PS was 4.53 + 3.68 at T1 and 3.73 + 3.61 at T2. Time to T1 was 2 hours 41 min + 4 hours 55 min, and T2 was 3 hours 1 min + 3 hours 14 min. For T1, 59.12% received narcotics/induction, 15.33% non-narcotic, 6.57% an anxiolytic, 0.73% a NSAID, and 18.25% no medication. At T2, 48.15% received narcotics/induction, 12.59% non-narcotic, 8.89% an anxiolytic, 1.48% a NSAID, and 28.89% no medication. For T1, increasing age per year decreased time to T1 by 7.32%, p=0.011, but ISS (p=0.089) and PS (p=0.065) had no effect. At T2, neither age, ISS nor PS impacted time to pain medication.
Conclusions (implications for practice): Significant variability exists on timing and type of pain medicine for pediatric trauma patients. Age, but not PS nor ISS, impact timing of pain medication. Further study is needed on trauma pain management, especially in younger patients.
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