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Effects of the Introduction of Intranasal Fentanyl on Reduction of Pain Severity Score in Children

An Interrupted Time-Series Analysis

Lord, Bill PhD*; Jennings, Paul A. PhD†,‡,§,∥; Smith, Karen PhD¶,#

doi: 10.1097/PEC.0000000000001376
Original Articles

Objectives Children are at risk of inadequate analgesia due to paramedics' inexperience in assessing children and challenges in administering analgesics when the patient is distressed and uncooperative. This study reports on the outcome of a change to practice guidelines that added intranasal fentanyl and intramuscular morphine within a large statewide ambulance service.

Methods This retrospective study included patients younger than 15 years treated by paramedics between January 2008 and December 2011. The primary outcome of interest was the proportion of patients having a 2/10 or greater reduction in pain severity score using an 11-point Verbal Numeric Rating Scale before and after the intervention. Segmented regression analysis was used to estimate the effect of the intervention over time. A multiple regression model calculated odds ratios with 95% confidence intervals.

Results A total of 92,378 children were transported by paramedics during the study period, with 9833 cases included in the analysis. The median age was 11 years; 61.6% were male. Before the intervention, 88.1% (n = 3114) of children receiving analgesia had a reduction of pain severity of 2 or more points, with 94.2% (n = 5933) achieving this benchmark after intervention (P < 0.0001). The odds of a reduction in pain of 2 or more points increased by 1.01 per month immediately before the intervention and 2.33 after intervention (<0.0001).

Conclusions This large study of a system-wide clinical practice guideline change has demonstrated a significant improvement in the outcome of interest. However, a proportion of children with moderate to severe pain did not receive analgesia.

From the *School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, Queensland

Department of Community Emergency Health and Paramedic Practice, Monash University, Clayton

Ambulance Victoria

§Emergency & Trauma Centre, The Alfred Hospital, Melbourne

College of Health and Biomedicine, Victoria University, Footscray, Victoria

Department of Research and Evaluation, Ambulance Victoria, Melbourne

#Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.

Disclosure: The authors declare no conflict of interest.

Reprints: Bill Lord, PhD, School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC QLD 4558, Australia (e-mail:

Online date: December 2, 2017

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