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28 Pain management of pediatric trauma patient in a prehospital medical service
  1. SI Montero,
  2. CL Villamor,
  3. JA Lara,
  4. T Casado,
  5. PJ Uriarte,
  6. F Miguel
  1. SAMUR Civil Protection, Emergency Medical Service, Madrid, Spain


Background Pain produced by trauma events is one of the most common problems of prehospital settings. However, pain control in children continues being a challenge for health professionals due to different barriers. This study aims at reviewing if the use of pharmacological methods for pain provided during the emergency care of pediatric trauma patients is proper.

Method Retrospective study of 560 consecutive clinical records of trauma patients, aged from 0 to 18, assisted from March to December 2017 by Advanced Life Support Units. Minor injuries excluded.

Results Median age was 12 years (IQR 8–15). 71.8% (402) males. The most common diagnoses were upper limbs fractures and dislocations 38.4% (215), 6.3% (35) major traumas. Pain assessment scales were used in 16.6% (93). Children received analgesia in 44.1% (247),>6 years were 50.5% (221) and ≤6 210.3% (26), p<0001. Fentanil was used in 78.5%(194) followed by Acetaminophen 20.6%(51), Ketorolac 17%(42) and Ketamine 8.9 (22). Midazolam was associated in 35.2%(84). Analgesia in major trauma was 74.3% with respect to serious wounds and brain injuries 10.8% p<0,001. Intravenous route was favourite 74% (183), followed by intranasal, 20.2% (50).

Conclusion The study demonstrates that, according to international guidelines, major trauma analgesia is greater than another groups, but not generalized. Intravenous infusion opioids are the main pharmacological method. However, pain scales are insufficiently applied and there is often a pain undertreatment, particularly in the youngest. Promoting suitable pain scales and alternatives to intravenous route like intranasal could increase treatment.


  1. Gausche-Hill M, Brown KM, Oliver ZJ, Sasson C, Dayan PS, Eschmann NM, et al. An Evidence-based Guideline for prehospital analgesia in trauma. Prehosp Emerg Care 2014;18 Suppl 1:25–34.

  2. Rutkowska A, Skotnicka-Klonowicz G. Prehospital pain management in children with traumatic injuries. Pediatr Emerg Care 2015 05;31(5):317–320.

  3. Browne LR, Shah MI, Studnek JR, Ostermayer DG, Reynolds S, Guse CE, et al. Multicenter Evaluation of Prehospital Opioid Pain Management in Injured Children. Prehosp Emerg Care 2016 11/20;20(6):759–767.

Conflict of interest None.

Funding None.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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