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Updated: May 7, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
A Delphi study to identify indicators of poorly managed pain for pediatric postoperative and procedural pain
Insights
This study developed preliminary indicators for undertreated pediatric pain, aiming to identify and manage it as an adverse healthcare event. Further research is needed to validate these indicators in clinical practice.
Area of Science:
- Pediatric Healthcare
- Patient Safety
- Pain Management
Background:
- Adverse health care events are injuries from patient care; undertreated pediatric pain may qualify.
- Currently, no validated indicators exist for undertreated pain in children.
- Pain management is crucial for pediatric patient outcomes.
Purpose of the Study:
- To create a preliminary list of indicators for undermanaged pain in hospitalized children.
- To establish a foundation for treating undertreated pediatric pain as an adverse event.
Main Methods:
- The Delphi technique surveyed pediatric pain management and quality improvement experts.
- Two rounds of electronic questionnaires were used to gather and refine potential indicators.
- Expert consensus (≥70%) was sought for indicator validation.
Main Results:
- A consensus was reached on most indicators for undertreated pediatric pain.
- Distinct indicators were identified for postoperative and procedural pain.
- Indicators were categorized for chart review versus direct observation/assessment.
Conclusions:
- The developed indicators are a first step toward recognizing mismanaged pain as an adverse event.
- Clinical usability and effectiveness of these indicators require further testing.
- This research provides a foundation for improving pediatric pain management and patient safety.
Background:
Adverse health care events are injuries occurring as a result of patient care. Significant acute pain is often caused by medical and surgical procedures in children, and it has been argued that undermanaged pain should be considered to be an adverse event. Indicators are often used to identify other potential adverse events. There are currently no validated indicators for undertreated pediatric pain.
Objectives:
To develop a preliminary list of indicators of undermanaged pain in hospitalized pediatric patients.
Methods:
The Delphi technique was used to survey experts in pediatric pain management and quality improvement. The first round used an electronic questionnaire to ask: "In your opinion, what indicators would signify that acute pain in a child has not been adequately controlled?" Responses were grouped together in semantically similar themes, providing a list of possible adverse event indicators. Using this list, an electronic questionnaire was developed for round 2 asking respondents to indicate the importance of each potential indicator.
Results:
All but one indicator achieved a level of consensus ≥70%. Separate indicators emerged for postoperative and procedural pain. An additional distinction was made between indicators that could be identified by chart review and those requiring observation of practice and assessment from the child or parent.
Discussion:
The adverse care indicators developed in the present study require further refinement. There is a need to test their clinical usability and to determine whether these indicators actually identify undermanaged pain in clinical practice. The present study is an important first step in identifying undermanaged pain in hospital and treating it as an adverse event.
Conclusion:
The adverse care indicators developed in the present study are the first step in conceptualizing mismanaged pain as an adverse event.
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