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Risk factors associated with higher pain levels among pediatric burn patients: a retrospective cohort study
Maleea D Holbert1,2, Roy M Kimble3,4, Lee V Jones5,6
1Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, South Brisbane, Queensland, Australia m.holbert@uq.edu.au.
Insights
Predictors of moderate to severe procedural pain in pediatric burn patients were identified. Factors like burn location, depth, size, and initial treatment influenced pain levels during the first dressing change.
Area of Science:
- Pediatric Burn Care
- Pain Management
- Clinical Research
Background:
- Limited evidence exists on predictors of moderate to severe pain in children with acute burns.
- Understanding these predictors is crucial for effective pain management during treatment.
Purpose of the Study:
- To identify patient and clinical characteristics associated with moderate to severe pain in pediatric burn patients during their first dressing change.
- To inform targeted pain control strategies for vulnerable children.
Main Methods:
- Retrospective cohort study of 2013 pediatric burn patients at Queensland Children's Hospital.
- Data included patient/burn characteristics, first aid, and follow-up care.
- Pain scores were categorized; logistic regression analyzed relationships between factors and pain.
Main Results:
- Hand/foot burns, deep dermal partial-thickness injuries, larger burn size, and multiple affected regions increased pain odds.
- Higher baseline pain, initial treatment at non-burns centers, and longer hospital presentation time were also associated with increased pain.
- Factors like hand burns (OR 1.7), deep dermal partial-thickness injuries (OR 7.9), and baseline pain (OR 5.5) significantly predicted moderate to severe pain.
Conclusions:
- Specific burn characteristics and treatment factors predict moderate to severe procedural pain in pediatric burn patients.
- Identifying these factors pre-dressing change allows for proactive implementation of enhanced pain control measures.
- This study provides evidence to guide clinical practice in managing procedural pain in pediatric burn care.
Introduction:
There is an absence of evidence regarding predictors of moderate to severe pain in children undergoing acute burn treatment. This investigation aimed to determine if relationships existed between patient and clinical characteristics, and pain at first dressing change for children with acute burn injuries.
Methods:
A retrospective cohort investigation was conducted using clinical data from pediatric burn patients treated at the Queensland Children's Hospital, Brisbane, Australia. Data extracted included patient and burn characteristics, first aid, and follow-up care. Observational pain scores were categorized into three groups (mild, moderate, and severe pain), and bivariate and multivariable relationships were examined using proportional odds ordinal logistic regression. Data from 2013 pediatric burns patients were extracted from the database.
Results:
Factors associated with increased odds of procedural pain included: hand burns (OR 1.7, 95% CI 1.3 to 2.1, p<0.001), foot burns (OR 1.5, 95% CI 1.1 to 2.1, p<0.01), baseline pain (OR 5.5, 95% CI 2.8 to 10.8, p<0.001), deep dermal partial-thickness injuries (OR 7.9, 95% CI 4.0 to 15.6, p<0.001), increased burn size (OR 1.1, 95% CI 1.0 to 1.2, p<0.01), four or more anatomical regions burned (OR 3.6, 95% CI 1.5 to 8.6, p<0.01), initial treatment at a non-burns center (OR 1.8, 95% CI 1.4 to 2.3, p<0.001), and time to hospital presentation (OR 0.9, 95% CI 0.8 to 0.9, p<0.001). These burn characteristics are associated with increased odds of moderate to severe procedural pain during a child's first dressings change.
Discussion:
It is recommended that patients presenting with one or more of the aforementioned factors are identified before their first dressing change, so additional pain control methods can be implemented.
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