TOP 33 - Time to Treatment of Pain in Trauma Activations in the Pediatric Emergency Department

Publication Number: 4736.TOP 33

Brittani Campelo, Maimonides Infants and Children's Hospital of Brooklyn, Jersey City, NJ, United States; Christine Rizkalla, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States

Background: Trauma, specifically unintentional injury, is the leading cause of death in children >1 year old, with approximately 12,000 children age 0-19 dying from unintentional injuries each year. It has specifically been found that analgesia use is low in children with fractures who are at risk for other associated multiple injuries, as in those presenting as traumas to the Emergency Department. Poorly controlled acute pain can lead to chronic pain syndromes and post-traumatic stress syndrome, therefore it is critical to treat acute pain at the earliest possible moment. Additionally, Black, Hispanic, and other minority patient groups are less likely than White patients to receive analgesics.

Objective: This project seeks to compare the time to pain medication administration in trauma activations as compared to walk-in and non-trauma activation EMS transport, in children age 0-15 years of age specifically with long bone injuries. The primary outcome is evaluation of the the time difference in analgesic administration starting from arrival in the ED to medication administration time between the two groups to determine if additional consideration needs to be given for more rapid pain control for the children presenting in the two groups.

Design/Methods: This is a single center retrospective comparative chart review comparing time to analgesia administration in patients that present as trauma notifications vs non-trauma notifications with long bone injuries for children 0-15 years old from January 2019-August 2025. The electronic medical record was queried for all patients meeting inclusion criteria (tibia, fibula, humerus, radius, ulna fracture) with division into 2 groups based on trauma notification status. Data was collected for the primary outcome of time (minutes) to pain medication administration along with patient demographics, type of pain medication administered, prehospital analgesia, and arrival method. Given an estimated 25 patients in the trauma group, and an average expected time to treatment in the control group of 22.2 minutes with a standard deviation of 19, we would have 80% power at alpha 0.05 to detect a 15-minute difference in time to treatment with a sample size of 25 trauma patients and 225 control group patients. Time to treatment will be compared with a t-test, using percentages for all categorical variables and means with standard deviations or medians with lower and upper ranges for all continuous variables.