280 Sedation and Analgesia Use in Lumbar Punctures at a Pediatric Tertiary Care Center

Abstract

Study Objectives: Pain is a common symptom after trauma. Previous studies have evaluated out-of-hospital analgesia during combat operations in Iraq and Afghanistan but were limited to the adult population. Pediatric care comprises a notable volume of medical care as part of combat operations. We sought to describe out-of-hospital analgesia in pediatric trauma patients during combat operations. Methods: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric subjects admitted to US and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. We separated subjects by age based on Centers for Disease Control age groupings: <1, 1-4, 5-9, 10-14, 15-17. Descriptive and inferential statistics were utilized. Binary logistic regressions were performed to determine odds ratios. High/low injury severity scores (ISS) values utilized a cut off of >15 and <15, respectively. Results: During the study period, there were 3439 pediatric trauma encounters, of which 614 (17.9% of database) patients received a total of 703 administrations of analgesia. Of the total analgesic administrations, morphine was the most common at 46.2% (n¼325), followed by fentanyl 30.4% (n¼214) and ketamine 17.4% (n¼122). An ISS of >15 did not significantly increase the likelihood of receiving an analgesic agent. The following interventions were associated with receipt of an analgesic agent: wound dressing application, tourniquet placement, IV and IO placement, IV fluids, intubation and external warming. Conclusions: Overall, there were low rates of analgesia administration in this population. Those receiving analgesic agents had higher rates of concomitant interventions.