Prehospital pain management of injured children: A systematic review of current evidence

Objectives: Injury is a common cause of acute pain in children. The objective of this study was to analyze the available evidence in prehospital pain management of injured children. Methods: The Patient/Population, Intervention, Comparator, and Outcome question was as follows: "In pediatric patients requiring prehospital analgesia for traumatic injuries, what is the level of evidence (LOE) available for the safety and efficacy of pharmacologic interventions?" The electronic databases MEDLINE/PUBMED, EMBASE, and Google Scholar were searched to identify all the relevant articles published in electronic journals, books, and scientificWeb sites over the last 20 years. Studies were included if they reported on prehospital use of analgesics in injured children. Reviews, editorials, and surveys were excluded. Results: Nineteen studies met the inclusion criteria. Thirteen were pediatric studies and 6 were studies of both adults and children. Nine were nonrandomized studies with concurrent controls (LOE-2), and 10 were retrospective case series and chart reviews (LOE-4). A measurable effect of analgesia was consistently found when analgesics were provided en route to the hospital; however, most studies reported a relatively low rate of analgesic use. Conclusions: Only a few studies examined the efficacy of pediatric prehospital analgesia. Fentanyl at a dose of 1 to 3 μg/mg seems to have an accepted efficacy. The current level of evidence is insufficient to assess the safety profile of analgesics. The findings of this study suggest that the analgesic treatment of injured children in the prehospital setting is suboptimal.