After the scan: Timing of first analgesia relative to CT initiation in adult trauma patients.

OBJECTIVE: To measure the timing of first emergency department analgesia relative to CT initiation in adult trauma patients and evaluate its association with trauma activation level and CT scan scope. METHODS: We performed a retrospective cohort study of adult trauma patients at a Level I trauma center from May 2022 through April 2025. The primary analytic cohort included patients who underwent CT and received qualifying emergency department analgesia, with both timestamps documented. The primary outcome was first analgesia occurring after CT initiation. Modified Poisson regression estimated adjusted risk ratios for activation level and pan-scan status. RESULTS: Of 2663 patients in the primary cohort, 44.1% received first analgesia after CT initiation, as did 43.8% of the 2320-patient complete-case cohort. Injury Severity Score above 15 was present in only 6.3%. Compared with no activation, the adjusted risk ratio for first documented analgesia after CT initiation was 1.35 for Level 3, 1.70 for Level 2, and 2.38 for Level 1 activation (all P < 0.001). Pan-scan imaging remained independently associated with first documented analgesia after CT initiation (adjusted risk ratio 1.27, 95% CI 1.12-1.44). Adjusted predicted probability rose from 32.5% with no activation to 70.7% with Level 1 activation. CONCLUSION: First analgesia followed CT initiation in 44% of adult trauma patients who underwent CT imaging and received qualifying analgesia. Higher activation level and pan-scan imaging were independently associated with this sequence. These findings describe medication-imaging timing rather than undertreatment and support studying analgesia delivery alongside trauma imaging.