• Gregory Adam Whitley, Pippa Hemingway, Graham Richard Law, Caitlin Wilson, and Aloysius Niroshan Siriwardena.
• Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England, United Kingdom. Electronic address: gwhitley@lincoln.ac.uk.
• Am J Emerg Med. 2020 Jul 1; 38 (7): 1424-1430.

ObjectiveWe aimed to identify predictors of effective management of acute pain in children in the pre-hospital setting.MethodsA retrospective cross-sectional study using electronic clinical records from one large UK ambulance service during 01-Oct-2017 to 30-Sep-2018 was performed using multivariable logistic regression. We included all children <18 years suffering acute pain. Children with a Glasgow Coma Scale score of <15, no documented pain or without a second pain score were excluded. The outcome measure was effective pain management (abolition or reduction of pain by ≥2 out of 10 using the numeric pain rating scale, Wong-Baker FACES® scale or FLACC [face, legs, activity, crying and consolability] scale).Results2312 patients were included for analysis. Median (IQR) age was 13 (9-16), 54% were male and the cause of pain was trauma in 66% of cases. Predictors of effective pain management include children who were younger (0-5 years) compared to older (12-17 years) (adjusted odds ratio [AOR] 1.53; 95% confidence interval [CI] 1.18-1.97), administered analgesia (AOR 2.26; CI 1.87-2.73), attended by a paramedic (AOR 1.46; CI 1.19-1.79) or living in an area of low deprivation (index of multiple deprivation [IMD] 8-10) compared to children in an area of high deprivation (IMD 1-3) (AOR 1.37; CI 1.04-1.80). Child sex, type of pain, transport time, non-pharmacological treatments and clinician experience were not significant.ConclusionThese predictors highlight disparity in effective pre-hospital management of acute pain in children. Qualitative research is needed to help explain these findings.Copyright © 2019 Elsevier Inc. All rights reserved.

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