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Prehospital Analgesia For Children With Long Bone Fractures: Should We Be Doing More?
*Garrett D. Hall1, Remle P. Crowe1, Antonio R. Fernandez1, Scott S. Bourn1, *Bindi Naik-Mathuria2, Sally K. Snow3, Katherine Remick4, J. Brent Myers1
1ESO, Austin, TX;2Baylor College of Medicine / Texas Children's Hospital, Houston, TX;3Independent Pediatric Emergency and Trauma Nursing Consultant, Graham, TX;4University of Texas Dell Medical School, Austin, TX

Background (issue): Significant pain experienced by children with long bone fractures is often undertreated in hospital settings, yet few studies have examined prehospital analgesia practices.1,2 We sought to describe prehospital analgesia administration for children with long bone fractures.
Methods: Using the ESO Data Collaborative 2019 public-use research dataset (encompassing de-identified electronic health records from 1,322 EMS agencies), we included children 0-17 years with an initial Glasgow coma scale >13 and long bone fracture ICD-10 codes. We excluded basic life support agencies. We used multivariable generalized estimating equations to identify factors related to analgesia administration, controlling for agency clustering.
Findings: Our analysis included 676 children with long bone fractures transported by EMS. Median age was 12 years (IQR:9-15) and 69% were male. Median EMS transport time was 17.0 minutes (IQR:11.2-23.5). Intravenous access was obtained in 54% overall, yet in only 17% of patients under 6. A pain score was recorded for 87%. Median first pain score was 8 (IQR:6-10) and 57.5% received analgesia. Fentanyl was most common (51%). One-fourth of fentanyl administrations were intranasal. No intravenous access was associated with a 93% decrease in odds of analgesia (OR:0.07, 95%CI:0.04-0.11). Additionally, younger age, no documented pain score, and shorter transport times were associated with reduced odds of analgesia.
Conclusions: Many children with long bone fractures did not receive prehospital analgesia, especially younger children. Barriers to prehospital pediatric analgesia administration, particularly via non-intravenous routes, warrant further investigation.

Table1.Prehospital analgesia administration for children with long bone fractures, stratified by age
Overall N=676 n(col%)Prehospital Analgesia N=389 n(row%)No Prehospital Analgesia N=287n(row%)p-value
Age Category, years<0.01
<2 years1.0% (7)14.3% (1)85.7% (6)
2-5 years7.7% (52)32.7% (17)67.3% (35)
6-8 years15.1% (102)48.0% (49)52.0% (53)
9-12 years27.5% (186)60.8% (113)39.2% (73)
13-17 years48.7% (329)63.5% (209)36.5% (120)


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