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Comprehensive pain management protocol reduces children's memory of pain at discharge from the pediatric ED
Patrick J Crocker1, Eric Higginbotham, Benjamin T King
1Dell Children's Medical Center of Central Texas, University Medical Center at Brackenridge, Austin, TX 78752, USA.
Insights
Protocolized pain management in pediatric emergency departments (PEDs) improved patients' recalled pain scores. However, this approach did not significantly alter parental perception or reported pain levels at discharge.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Clinical Protocol Implementation
Background:
- Historically, inadequate pain management in pediatric emergency departments (PEDs) has led to adverse psychosocial outcomes.
- Effective pain management strategies are crucial for improving pediatric patient experiences and outcomes.
Purpose of the Study:
- To evaluate the impact of a protocolized pain management strategy on pediatric patients experiencing pain in the emergency department.
- To assess changes in patient and parental pain perception before and after protocol implementation.
Main Methods:
- A pre- and post-implementation analysis of the "Comfort Zone" protocol was conducted in a PED.
- Validated, age-appropriate pain scales were used to collect patient and parental pain scores at triage and discharge.
- Statistical analyses included Cronbach's alpha, confirmatory factor analysis, chi-squared, and Wilcoxon rank sum tests.
Main Results:
- Patients in the protocol group reported significantly lower recalled pain scores for the ED visit compared to the pre-protocol group (P < .001).
- Parental estimates of pain and patient/parent-reported pain at discharge did not show significant changes.
- Pain assessments in children younger than 4 years, relying solely on parental reports, showed no significant reduction.
Conclusions:
- Protocolized pain management effectively reduces patients' memory of pain experienced during PED visits.
- The implemented protocol did not significantly impact parental memory of perceived pain or patient/parent-reported pain at discharge.
Background:
Historically, pain has been poorly managed in the pediatric emergency department (ED) (PED), resulting in measurable psychosocial issues both acute and delayed.
Objective:
The aim of the study was to measure the impact of protocolized pain management on patients with painful conditions or undergoing painful procedures in the PED.
Methods:
We performed an analysis before and after the implementation of the protocol, dubbed the "Comfort Zone." Validated, age-appropriate pain scales were performed. Validation (using Cronbach α, confirmatory factor analysis) was followed by comparison of responses between the pre- and posttests collected (χ(2) and Wilcoxon rank sum tests). Pain scores were collected at triage and at discharge. At triage, patients were asked to report pain levels. At discharge, they were asked to report their current pain and recall the level of pain during their stay. At triage, parents were asked to report about their perception of the child's pain. At discharge, they were asked to report about their perception of the child's current pain and recall the level of pain during the stay and during procedures, if done.
Results:
Five hundred thirty-one patients were enrolled in the preprotocol group; 47% were women with a median age of 5 years (range, 30 days-18 years). Two hundred sixty-three patients were enrolled in the protocol group; 39% were women with a median age of 6 years (range, 30 days-18 years). Patient-recalled pain scores of the ED visit in the protocol group were significantly lower than those of the preprotocol group (Wong-Baker Faces Pain Scale, 5.07-4.01; P < .001); yet parent estimates of pain did not show a significant change at any point. Patient assessment of pain at ED discharge did not show a significant change either (Wong-Baker Faces Pain Scale, 1.99-1.56; P = .09). The Faces scale is not well validated for patients younger than 4, so that group had only parental assessment of pain and, consistent with the larger data set, showed no significant pain scale reduction at any point.
Conclusion:
Protocolized pain management reduces patients' memory of pain during PED visits but may not affect parental memory of perceived pain or parent- and patient-reported pain at discharge.
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