Table 9 Characteristics of the included studies
From: The effectiveness and safety of paediatric prehospital pain management: a systematic review
Author, year, country | Funding, conflict of interest | Study design, (LOE) | Age groups, Median age in years (IQR) | Total No. of Patients | The commonly reported etiology | Pain Assessment Tool | Drug name, route, initial dose | Initial pain score (Among the recorded pain scale) | Reduction of pain severity | Adverse event |
|---|---|---|---|---|---|---|---|---|---|---|
Bredmose P. 2009 [35], UK | Reported, None | Retrospective database review (LOE 4) | Pediatrics, 10 (0–15)** | 164 | Trauma (road traffic accident, burns, and fall) | NR* | Ketamine, IV/IM, mean dose 1.0 mg/kg (range 0.1–5.8), | NR* | NR* | Desaturation (< 4%) |
Karlsen, A. P. H. 2013 [32], Denmark | Reported, None | Prospective data review (LOE 4) | Adult and pediatrics, 15 (13–16) | Only pediatrics (63) | Nonspecific | Numeric rating scale | Fentanyl, intranasal, 50 µg (mean cumulative dose of 114 µg), | Median initial pain score (IQR) 8 (7–9) | Median reduction in pain score (IQR) 4 (2–5) | No serious adverse events. Commonly observed adverse events were hypotension, nausea, and vomiting, transient GCS reduction, vertigo, fatigue, worsening of abdominal pain, and rash |
Murphy, A. P. 2017 [37], Ireland | Reported, None | Prospective chart review (LOE 4) | Pediatrics, 11 (7–13) | 94 | Trauma | Either FLACC, the Wong-Baker Faces, or the Verbal numerical rating scale | Fentanyl, intranasal, mean (SD) 50 µg (± 10 µg) | Median initial pain score (IQR) 10 (8–10) | Median (IQR) pain score reduction of 4 (P < 0.001; [2–6 | No observed adverse events |
Bendall, J. C 2011 [36], Australia | NR*, None | Retrospective chart review (LOE 4) | Pediatrics, 13 (11–14) | 3312 | Trauma, abdominal pain, back pain, and other (nonspecific) | Verbal numerical rating scale | Morphine, IV, 0.1 mg/kg for children aged 5-12 years and 2.5–5.0 mg for children > 12yrs, Fentanyl, intranasal, 45-60 mg (1–5 yrs), 60-75 mg (6-12yrs), 180 mg (13-15yrs), Methoxyflurane, inhalational, (0.2%-0.4%) 3 ml | Median initial pain score (IQR) 8(7–10) | Median pain score reduction (IQR) 5(3–6) | NR* |
Jennings, P. A. 2015 [33], Australia | NR*, NR* | Retrospective data review (LOE 4) | Pediatrics 11 (9–13) | 15,016 | Musculoskeletal injury, and others (including medical cause) | Verbal numerical rating scale, the Wong-Baker Faces pain scale, FLACC, and use of adjectives | Methoxyflurane, inhalational, NR* Fentanyl, intranasal/IV, NR* Morphine, IV, NR* | Median initial pain score (IQR) 7 (5–8) | Median pain score reduction (IQR) 4 (2–6) | NR* |
Lord, B. 2016 [31], Australia | NR*, None | Retrospective database review (LOE 4) | Pediatrics 10 (5–12 | 38,167 | Musculoskeletal (commonly from fall), burns, poisoning, other trauma, cardiac and other causes | Verbal numerical rating scale, the Wong-Baker Faces pain scale, FLACC, and use of adjectives | Fentanyl, intranasal, NR* Methoxyflurane, inhalational, NR* Morphine, IV (65%), NR* | Median initial pain score (IQR) 3 (2–7) | Median pain score reduction (IQR) 2 (0–5) | NR* |
Babl F.E. 2006 [30], Australia | NR*, None | Prospective case series (LOE 4) | Pediatrics 11 (8.6–13.5) | 105 | Extremity injury, abdominal pain, head/facial injury, burn, and multi-trauma | Verbal numerical rating scale | Methoxyflurane, inhaled, 3 ml (91.4%) and 6 ml (8.6%) | Mean of 7.9 (95% CI 7.5–8.3) | Mean of 4.5 (95% CI 3.9–5.0) at 2-5 min and 3.2 (95% CI 2.8–3.7) | No major adverse events. Minor adverse events like drowsiness, hallucinations, vomiting, confusion/dyscoordination, dizziness, cough, headache, and others. No reported renal impairment |
Jacobs Ian G. 2010 [34], Australia, | Reported, None | Retrospective Cohort (LOE 3) | Adult and pediatrics, No specific pediatric median age | Only pediatrics (14,753) | Nonspecific | NR* | Methoxyflurane, inhaled, (0.3%) 3Â ml | NR* | NR* | No increased risk of disease |