Pain management in children and young adults with minor injury in emergency departments in the UK and Ireland: a PERUKI service evaluation.
Analgesia
Nursing Care
Pain
Pharmacology
Therapeutics
Journal
BMJ paediatrics open
ISSN: 2399-9772
Titre abrégé: BMJ Paediatr Open
Pays: England
ID NLM: 101715309
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
27
08
2021
accepted:
03
03
2022
entrez:
2
9
2022
pubmed:
3
9
2022
medline:
9
9
2022
Statut:
ppublish
Résumé
Management of acute pain should commence at the earliest opportunity, as it has many short-term and long-term consequences. A research priority of Paediatric Emergency Research in the UK and Ireland (PERUKI) was to examine paediatric pain practices. To describe the outcomes for paediatric pain management of minor injuries presenting to emergency departments (EDs) across PERUKI. A retrospective service evaluation was performed over a 7-day period in late 2016/early 2017 across PERUKI sites, and analysis performed using an adapted Donabedian framework. Patients under 16 years presenting with minor trauma were eligible, and data were collected on prehospital management, pain assessment, analgesia administered and injury diagnosed. Thirty-one sites submitted data on 3888 patients. There were 111 missed cases (missed rate 3.6%). The most common injuries were sprains, lacerations, contusions/abrasions and fractures. Documentation of receiving analgesia before arrival in ED occurred in 21% of patients (n=818). A pain assessment was documented in 57.5% of patients (n=2235) during their ED visit, and 3.5% of patients had their pain reassessed (n=138). Of the patients who presented in severe pain (pain score 7-10 or rated severe), 11% were reassessed. Site variability of initial pain assessment ranged from 1.4% to 100% (median 62%). The characteristics of the top quartile performing centres against the bottom quartile performing centres based on completion rate of initial pain scores were identified. Pain assessment was documented in under 60% of children with minor injury, re-assessment of pain was almost completely absent, data and outcomes were missing in a substantial volume of patients, indicating that pain management and the associated outcomes have not been adequately addressed and prioritised within existing network structures and processes.
Sections du résumé
BACKGROUND
Management of acute pain should commence at the earliest opportunity, as it has many short-term and long-term consequences. A research priority of Paediatric Emergency Research in the UK and Ireland (PERUKI) was to examine paediatric pain practices.
OBJECTIVE
To describe the outcomes for paediatric pain management of minor injuries presenting to emergency departments (EDs) across PERUKI.
METHODS
A retrospective service evaluation was performed over a 7-day period in late 2016/early 2017 across PERUKI sites, and analysis performed using an adapted Donabedian framework. Patients under 16 years presenting with minor trauma were eligible, and data were collected on prehospital management, pain assessment, analgesia administered and injury diagnosed.
RESULTS
Thirty-one sites submitted data on 3888 patients. There were 111 missed cases (missed rate 3.6%). The most common injuries were sprains, lacerations, contusions/abrasions and fractures. Documentation of receiving analgesia before arrival in ED occurred in 21% of patients (n=818). A pain assessment was documented in 57.5% of patients (n=2235) during their ED visit, and 3.5% of patients had their pain reassessed (n=138). Of the patients who presented in severe pain (pain score 7-10 or rated severe), 11% were reassessed. Site variability of initial pain assessment ranged from 1.4% to 100% (median 62%). The characteristics of the top quartile performing centres against the bottom quartile performing centres based on completion rate of initial pain scores were identified.
CONCLUSION
Pain assessment was documented in under 60% of children with minor injury, re-assessment of pain was almost completely absent, data and outcomes were missing in a substantial volume of patients, indicating that pain management and the associated outcomes have not been adequately addressed and prioritised within existing network structures and processes.
Identifiants
pubmed: 36053599
pii: 10.1136/bmjpo-2021-001273
doi: 10.1136/bmjpo-2021-001273
pmc: PMC8943777
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Milbank Q. 2005;83(4):691-729
pubmed: 16279964
Lancet Child Adolesc Health. 2021 Jan;5(1):47-87
pubmed: 33064998
Arch Dis Child. 2014 Jun;99(6):602-3
pubmed: 24615624
Emerg Med J. 2015 Nov;32(11):864-8
pubmed: 25678575
Arch Dis Child. 2019 Apr;104(4):366-371
pubmed: 30470686
Pediatrics. 2012 Nov;130(5):e1391-405
pubmed: 23109683
Emerg Med J. 2020 Feb;37(2):85-94
pubmed: 31831588
J Pain Symptom Manage. 1999 May;17(5):333-50
pubmed: 10355212
Ann Emerg Med. 2013 Oct;62(4):340-50
pubmed: 23787210
Med J Aust. 2016 May 2;204(8):315-7
pubmed: 27125806
JAMA. 1988 Sep 23-30;260(12):1743-8
pubmed: 3045356
BMJ Paediatr Open. 2021 Jul 26;5(1):e001159
pubmed: 34395928
Pain Res Manag. 2014 Nov-Dec;19(6):e179-90
pubmed: 25337856
Prehosp Emerg Care. 2016;20(1):52-8
pubmed: 26024309
Pediatr Emerg Care. 2007 Apr;23(4):223-6
pubmed: 17438434