Analgesia Administration in Severely Injured Pediatric Trauma Patients: A Comparison of General and Pediatric Emergency Departments.

Abstract

Introduction: The purpose of the study is to compare analgesia and sedation administration among pediatric major trauma patients managed in the pediatric emergency department (PED) versus the general emergency department (GED).

Methods: This retrospective cohort study included pediatric trauma patients (<16 years) with an injury severity score (ISS) >15 treated at a single trauma center. Between 2013 and 2015, patients were managed primarily by surgeons in the GED; between 2019 and 2023, by pediatric emergency medicine physicians in the PED, following a 3-year transition period. Data on demographics, injury characteristics, pain assessment, and analgesia/sedation were extracted from the trauma registry and medical records. The primary outcome was analgesia administration rate. Secondary analyses compared provider type and analgesia rates between pediatric and adult trauma patients treated in the GED.

Results: Seventy-three pediatric patients met inclusion criteria (GED: 36; PED: 37). ISS scores were similar (GED: 16 [interquartile range (IQR) 16-19.5] vs. PED: 17 [IQR 16-21], P = 0.16). Analgesia was administered to 48.6% of PED patients versus 33.3% in the GED (P = 0.18). Opioid use was 19% versus 13.8%, and sedative use was 21.6% versus 8.3%, respectively. Pain score documentation was more consistent in the PED. Children treated in the GED received significantly less analgesia than adults with similar ISS scores treated in the same department (33.3% vs. 78.3%, P < 0.0001).

Conclusions: Analgesia administration in severely injured children remained low across both emergency settings. While trends suggested improved management in the PED, findings may reflect broader changes in care over time, highlighting the ongoing need for standardized pain assessment and treatment protocols in pediatric trauma care.