Out-of-hospital emergency medicine in pediatric patients: prevalence and management of pain

Am J Emerg Med. 2011 Nov;29(9):1062-6. doi: 10.1016/j.ajem.2010.06.031. Epub 2010 Aug 3.


Introduction: Much less is known about pain prevalence in pediatric patients in an out-of-hospital than emergency department setting. The purpose of this study was to determine pain prevalence in children in a prehospital emergency setting and to identify the factors associated with pain relief.

Materials and methods: This prospective cohort study in consecutive patients 15 years or younger was conducted by 5 mobile intensive care units working 24/7 (January-December 2005). The presence of pain, its intensity, and alleviation by the administration of analgesics were recorded.

Results: A total of 258 of 433 pediatric patients were included, of whom 96 were suffering from acute pain (37%; 95% confidence interval [CI], 31-43) that was intense to severe in 67% of cases. Trauma was the only factor significantly associated with acute pain (odds ratio, 818; 95% CI, 153-4376). Overall, 92% of the children in pain received at least one analgesic drug; 41% received a combination of drugs. Opioid administration was significantly associated with intense to severe pain (odds ratio, 7; 95% CI, 2-25). On arrival at hospital, 67% of the children were still in pain; but 84% had experienced some pain relief regardless of their sex, age, or disorder.

Conclusion: In a prehospital emergency setting, more than a third of children experience acute pain with a high prevalence of intense to severe pain. Scoring pain in children, and especially in the newborn, is beleaguered by a lack of suitable scales. Despite this, it was possible to treat 90% of children in pain and provide relief in 80% of cases.

MeSH terms

  • Adolescent
  • Age Factors
  • Analgesics / therapeutic use*
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Emergency Medical Services* / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Male
  • Pain / drug therapy*
  • Pain / epidemiology
  • Pain Measurement
  • Prevalence
  • Prospective Studies


  • Analgesics