Lord Bill, Jennings Paul A, Smith Karen
School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore, Sunshine Coast, Queensland, Australia.
Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2016 Jun;28(3):319-24. doi: 10.1111/1742-6723.12586. Epub 2016 May 5.
The present study aimed to describe paramedic assessment and management of pain in children in a large state-wide ambulance service.
A retrospective cohort study included paediatric patients (aged less than 15 years) treated and transported by paramedics in the Australian state of Victoria between 1 January 2008 and 31 December 2011. Primary outcome measures were the frequency of analgesic administration and odds of receiving any analgesic (morphine, fentanyl or methoxyflurane). Data were analysed by descriptive statistics, χ(2) -test and logistic regression to test the association between analgesic administration and the explanatory variables.
There were 38 167 cases that included a description of pain and where any pain scores were >0. Median age was 10 years (IQR 5-12), 59.2% were male and 15 090 (39.5%) received any analgesic. Of patients reported to have severe pain (verbal numeric rating scale 8-10), only 45% (n = 6084) received any analgesia. In unadjusted analysis, patients aged >9 years were more likely to receive analgesia than those aged <3 years (unadjusted odds ratio 4.39, 95% confidence interval 4.01-4.80). Multiple regression analysis found that significant predictors of analgesic administration were patient's sex, patient age, type of pain, initial pain score and case year.
Disparities in analgesic administration based on age and the low rate of pain scores documented in very young children identified in the present study should inform strategies that aim to improve the assessment and management of pain in children.
本研究旨在描述在一个大型全州范围的救护车服务中，护理人员对儿童疼痛的评估和处理情况。
一项回顾性队列研究纳入了2008年1月1日至2011年12月31日期间在澳大利亚维多利亚州由护理人员治疗和转运的儿科患者（年龄小于15岁）。主要结局指标是镇痛药物使用频率以及接受任何镇痛药物（吗啡、芬太尼或甲氧氟烷）的几率。通过描述性统计、χ²检验和逻辑回归分析数据，以检验镇痛药物使用与解释变量之间的关联。
共有38167例病例包含疼痛描述且任何疼痛评分>0。中位年龄为10岁（四分位间距5 - 12岁），59.2%为男性，15090例（39.5%）接受了任何镇痛药物。在报告有严重疼痛（言语数字评定量表8 - 10）的患者中，仅45%（n = 6084）接受了任何镇痛治疗。在未调整分析中，年龄>9岁的患者比年龄<3岁的患者更有可能接受镇痛治疗（未调整比值比4.39，95%置信区间4.01 - 4.80）。多元回归分析发现，镇痛药物使用的显著预测因素是患者性别、患者年龄、疼痛类型、初始疼痛评分和病例年份。
本研究中发现的基于年龄的镇痛药物使用差异以及非常年幼儿童记录的低疼痛评分率，应为旨在改善儿童疼痛评估和处理的策略提供参考。
