789 - Assessment of pain and provision of non-pharmacologic analgesia to children by prehospital providers in Southwestern Ontario: a cross-sectional study
Research Assistant London Health Science Centre London, Ontario, Canada
Background: There is abundant evidence that in children, management of pain by prehospital providers is suboptimal. Most paediatric calls are performed by primary care paramedics (PCPs) who are unable to administer pharmacologic analgesia to children but can administer non-pharmacologic therapies. We sought to describe the proportion of children provided non-pharmacologic analgesia by prehospital providers.
Objective:
Design/Methods: We reviewed all ambulance call reports (ACRs) of children 0-17 years with acutely painful conditions (headache, abdominal pain, injury, head/ears/eyes/nose/throat pain, and back pain) who were transported to a paediatric tertiary referral centre serving a catchment of > 1 million from 2017-2019. Data collection was recorded by two blinded assessors using a study specific ExcelTM sheet. The primary outcome was the proportion of children offered non-pharmacologic analgesia. We performed a stepwise logistic regression on the primary outcome using covariates defined a priori: age, sex, visible deformity, type of crew, complaint, pain score, call time and prior analgesia.
Results: All 11,084 ACRs from January 1, 2017 – December 31, 2019 were reviewed. The sample included 5887/11084 (53.1%) males, ranging from 1 month – 17 years, with a mean (SD) age of 10.5 (5.6) years. Calls involved mainly PCPs [8576/11084 (77.4%)]. Non-trauma related musculoskeletal injuries were most common, comprising 2743/11,084 (24.7%) of calls. Pain scores were documented in 6947/11084 (62.7%) of calls. The verbal numeric rating scale (0-10) was used in 5022/6947 (72.3%) calls, with a mean (SD) score of 5.2 (3.2). Non-pharmacologic analgesia was provided in 2926/11084 (26.4%) of calls, most commonly splint (1115/2926, 38.1%) and ice (931/2926, 31.8%). Pharmacologic analgesia was provided in 458/11084 (4.1%) of calls. In the multivariate model, mild (OR: 3.2; 95% CI: 2.3, 4.4; p<0.001) and moderate pain (OR: 1.7; 95% CI: 1.3, 2.2) (versus no pain) were significant predictors of non-pharmacologic analgesia, whereas and visible deformity (OR 0.5; 95% CI: 0.3, 0.6; p<0.001) was a significant negative predictor. Conclusion(s): The provision of non-pharmacologic analgesia to children in Southwestern Ontario by prehospital providers is suboptimal despite moderate to severe pain. There is a clear need for education surrounding approaches to non-pharmacologic analgesia in children among prehospital providers.
Authors/Institutions: Karina Burke, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada; Branka Vujcic, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada; Charlotte Mace, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada; Jonathan Hamilton, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada; John Teefy, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada; Naveen Poonai, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
