Effect of introducing the mucosal atomization device for fentanyl use in out-of-hospital pediatric trauma patients

摘要

Background: Pain associated with pediatric trauma is often under-assessed and undertreatedin the out-of-hospital setting. Administering an opioid such as fentanyl via theintranasal route is a safe and efficacious alternative to traditional routes of analgesicdelivery and could potentially improve pain management in pediatric trauma patients.Objective: The study sought to examine the effect of introducing the mucosal atomizationdevice (MAD) on analgesia administration as an alternative to intravenous fentanyldelivery in pediatric trauma patients. The hypothesis for the study is that the introductionof the MAD would increase the administration of fentanyl in pediatric trauma patients.Methods: The research utilized a 2-group design (pre-MAD and post-MAD) to study946 pediatric trauma patients (age ,16) transported by a large, urban EMS agency to oneof eight hospitals in Marion County, which is located in Indianapolis Indiana. Twoemergency medicine physicians independently determined whether the patient metcriteria for pain medication receipt and a third reviewer resolved any disagreements.A comparison of the rates of fentanyl administration in both groups was then conducted.Results: There was no statistically significant difference in the rate of fentanyl administrationbetween the pre-MAD (30.4%) and post-MAD groups (37.8%) (P5.238).A subgroup analysis showed that age and mechanism of injury were stronger predictors offentanyl administration.Conclusion: Contrary to the hypothesis, the addition of the MAD device did notincrease fentanyl administration rates in pediatric trauma patients. Future research isneeded to address the barriers to analgesia administration in pediatric trauma patients.