Injury Severity and Time to Documented Analgesia in Emergency Department Trauma Patients.

BACKGROUND: Delays in analgesia remain common after traumatic injury, but whether greater injury severity is associated with faster analgesia is not well defined. OBJECTIVES: We evaluated the association between Injury Severity Score (ISS) and time to first documented emergency department analgesia. METHODS: We conducted a retrospective cohort study of adult trauma registry encounters at a Level I trauma center from May 1, 2022, through April 30, 2025. The primary outcome was time from emergency department arrival to first documented qualifying analgesic administration. Patients without documented analgesia were censored at emergency department departure. Cox models evaluated ISS continuously and by categories: 1 to 8, 9 to 15, 16 to 24, and 25 or greater. Secondary outcomes were analgesia within 30 and 60 minutes. RESULTS: Among 6,095 included encounters, the primary ISS analytic cohort included 5,093. Overall, 3,072 patients received documented analgesia (60.3%). Median time to documented analgesia was 104.5 minutes (IQR 56.0-206.1). Analgesia was documented within 30 minutes in 220 patients (4.3%) and within 60 minutes in 836 patients (16.4%). Higher ISS was associated with shorter time to documented analgesia (hazard ratio 1.028 per ISS point; 95% CI 1.023 to Y1.034). Categorical and sensitivity analyses showed a nonlinear association: ISS 9-15 and ISS 16-24 were associated with faster documented analgesia, whereas ISS 25 or greater had the lowest rates of early documented analgesia. CONCLUSION: Injury severity was associated with documented analgesic timing in a nonlinear pattern, with the lowest rates of early documented analgesia among the most severely injured patients.