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Published on: February 23, 2024
Pain in young children with burns: extent, course and influencing factors
Alette E E de Jong1, Marco Bremer2, Rob van Komen3
1Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands; Association of Dutch Burn Centres, Beverwijk, The Netherlands.
Insights
Pain management in young children with burns requires attention, as background pain is better treated than procedural pain. Factors like burn size and surgical procedures influence pain levels, guiding future treatment strategies for pediatric burn patients.
Area of Science:
- Pediatric Burn Care
- Pain Management
- Clinical Nursing Research
Background:
- Limited data exists on pain extent, course, and influencing factors in young children with burns.
- Availability of reliable pain assessment tools enables new research insights.
- Understanding pediatric burn pain is crucial for improving patient outcomes.
Purpose of the Study:
- To document the extent and course of pain behavior using the COMFORT-B scale in pediatric burn patients.
- To establish clinically relevant cutpoints for the COMFORT-B scale via Rasch analysis.
- To identify factors influencing procedural pain in young children with burns.
Main Methods:
- Rasch analysis to determine COMFORT-B score cutpoints for pain severity.
- Descriptive statistics to assess background and procedural pain.
- Latent growth modeling to investigate pain course and influencing factors.
- Data collected by trained nurses from 168 children (mean age 20 months, TBSA 6%).
Main Results:
- Established COMFORT-B cutpoints: 6-13 (mild), 14-20 (moderate), 21-30 (severe) pain.
- Background pain appears better managed than procedural pain in this cohort.
- Influencing factors for pain included Total Surface Area (TBSA) burned, surgical procedures, prior acetaminophen use, and dressing type.
Conclusions:
- Pediatric burn pain, particularly procedural pain, requires enhanced management strategies.
- Identifying key factors influencing pain allows for targeted interventions.
- Findings provide evidence-based recommendations for optimizing pain care in young burn survivors.
Abstract:
Little evidence is available on the extent, course and influencing factors of pain in young children with burns. At present, reliable and valid measurement instruments to assess pain behavior in these children are available, implying that valuable insight into these questions can now be obtained. The aim of this study is to document the extent and course of pain behavior with the COMFORT-B, and to assess factors that may influence procedural pain. First, cutpoints for COMFORT-B scores were established by Rasch analysis to assess clinically relevant changes. Second, the extent of background and procedural pain behavior was assessed by descriptive statistics. Third, the course and factors that may influence procedural pain behavior were investigated by latent growth modeling. Trained nurses collected pain behavior data in 168 children (mean age 20 months, mean TBSA 6%, mean length of stay 10 days). Cutpoints of COMFORT-B scores were as follows: 6-13 (mild pain), 14-20 (moderate pain) and 21-30 (severe pain). This study suggests that background pain is more adequately treated than procedural pain. Factors that influenced baseline pain scores and/or the course over 8 days included TBSA, the number of surgical procedures, acetaminophen administration by the referring hospital, and the application of hydrofiber dressings. The implications of these findings are discussed.
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