Age-Associated Variation in Documented Emergency Department Analgesia Among Pediatric Trauma Patients in a Painful Injury Cohort

OBJECTIVES: Young children may be at risk for less frequent analgesic administration after injury because pain assessment and communication are more difficult. We evaluated whether age younger than 6 years was associated with less frequent ED analgesic administration among pediatric trauma registry patients with painful injuries. METHODS: We performed a retrospective cohort study of trauma registry patients aged 18 years or younger evaluated in an emergency department from May 2022 through April 2025. The primary painful injury cohort included patients with injury descriptors consistent with fracture, dislocation, burn, laceration, open wound, crush injury, amputation, degloving injury, or avulsion injury. The primary outcome was any documented administration of ED analgesics. We used modified Poisson regression with robust standard errors to estimate relative risks. RESULTS: ED analgesia was recorded in 54 of 126 younger children (42.9%) compared with 133 of 193 older children (68.9%), an absolute difference of 26.1 percentage points. In unadjusted analysis, age younger than 6 years was associated with a lower likelihood of ED analgesia (RR: 0.62; 95% CI: 0.50-0.78). After adjustment for Injury Severity Score, sex, mechanism, transport mode, trauma activation level, and ED disposition, age younger than 6 years remained associated with a lower likelihood of ED analgesia (adjusted relative risk: 0.66; 95% CI: 0.53-0.83). CONCLUSIONS: Children younger than 6 years with painful injuries had less frequent ED analgesic administration than older children.