Predictors of effective management of acute pain in children within a UK ambulance service: A cross-sectional study

Gregory Adam Whitley, Pippa Hemingway, Graham Richard Law, Caitlin Wilson, Aloysius Niroshan Siriwardena

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: We aimed to identify predictors of effective management of acute pain in children in the pre-hospital setting.

METHODS: A retrospective cross-sectional study using electronic clinical records from one large UK ambulance service during 01-Oct-2017 to 30-Sep-2018 was performed using multivariable logistic regression. We included all children <18 years suffering acute pain. Children with a Glasgow Coma Scale score of <15, no documented pain or without a second pain score were excluded. The outcome measure was effective pain management (abolition or reduction of pain by ≥2 out of 10 using the numeric pain rating scale, Wong-Baker FACES® scale or FLACC [face, legs, activity, crying and consolability] scale).

RESULTS: 2312 patients were included for analysis. Median (IQR) age was 13 (9-16), 54% were male and the cause of pain was trauma in 66% of cases. Predictors of effective pain management include children who were younger (0-5 years) compared to older (12-17 years) (adjusted odds ratio [AOR] 1.53; 95% confidence interval [CI] 1.18-1.97), administered analgesia (AOR 2.26; CI 1.87-2.73), attended by a paramedic (AOR 1.46; CI 1.19-1.79) or living in an area of low deprivation (index of multiple deprivation [IMD] 8-10) compared to children in an area of high deprivation (IMD 1-3) (AOR 1.37; CI 1.04-1.80). Child sex, type of pain, transport time, non-pharmacological treatments and clinician experience were not significant.

CONCLUSION: These predictors highlight disparity in effective pre-hospital management of acute pain in children. Qualitative research is needed to help explain these findings.

Original languageEnglish
Pages (from-to)1424-1430
Number of pages7
JournalAmerican Journal of Emergency Medicine
Issue number7
Publication statusPublished - Jul 2020
Externally publishedYes


  • Acute Pain/epidemiology
  • Adolescent
  • Ambulances
  • Analgesics/therapeutic use
  • Bandages
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Emergency Medical Services
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Pain Management
  • Pain Measurement
  • Retrospective Studies
  • Socioeconomic Factors
  • Splints
  • United Kingdom/epidemiology


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