Protocolized Pain Assessment and Management in Pediatric Trauma Patients.

Authors

• Oluwaseun Adeyemi
• Shareef Syed
• Vrindda Atrii
• Rohit Mukherjee
• Charoo Piplani
• Nicholas Baker
• Yisha Cheng, St. Christopher's Hospital for Children, Philadelphia, PA
• Amanda L Teichman
• Zachary Englert
• Arunachalam Thenappan
• Mark Baker
• Divya Kewalramani
• Mayur Narayan
• Rachel L Choron

Document Type

Article

Publication Date

7-7-2026

Abstract

INTRODUCTION: Pain in pediatric trauma patients is often under-assessed. A pain assessment and treatment (PAT) protocol was implemented to promote more consistent evaluation. This study examines its adoption and factors associated with adherence. We hypothesized that pain would be assessed more frequently following protocol adoption.

METHODS: A cross-sectional study of 908 pediatric trauma patients (ages 0-14) treated from 2021 to 2025 was conducted at a level II pediatric trauma center. The primary outcome was pain assessment. The predictors included sociodemographic, injury-related, and system-level factors. We reported the trend in protocol adoption and the pattern of adherence. Univariate and multivariate logistic regression were performed to assess factors associated with the adoption of the PAT protocol; the unadjusted and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported.

RESULTS: Of the 908 pediatric trauma patients, 79% (n = 720) had their pain assessed. Adherence to the PAT protocol increased from 62% in 2021 to 85% in 2023 and plateaued in 2024 and 2025 (79%). The median time from emergency department presentation to pain assessment was 14 min (IQR: 5.0, 31.5). Compared to infants and toddlers, pre-teens were 68% more likely to have their pain assessed in the emergency department (aOR: 1.73; 95% CI: 1.08 - 2.78). Patients who presented to the trauma resuscitation area as pediatric trauma activations were 62% (aOR: 0.38; 95% CI: 0.25 - 0.59) less likely to have their pain assessed than non-activation patients.

CONCLUSIONS: The adoption of the PAT protocol was associated with increased pain assessment among pediatric trauma patients. However, opportunities remain to improve pain assessment for the youngest patients (0-3 y) and those who arrive as trauma activations.

Publication Title

The Journal of surgical research

Volume

326

First Page

64

Last Page

73

Recommended Citation

Adeyemi, O., Syed, S., Atrii, V., Mukherjee, R., Piplani, C., Baker, N., Cheng, Y., Teichman, A., Englert, Z., Thenappan, A., Baker, M., Kewalramani, D., Narayan, M., & Choron, R. (2026). Protocolized Pain Assessment and Management in Pediatric Trauma Patients.. The Journal of surgical research, 326, 64-73. https://doi.org/https://doi.org/10.1016/j.jss.2026.06.001