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Reaching consensus on an analgesia protocol for paediatric burn patients in a resource-scarce South African community
Shelley L Wall1, Nikki L Allorto, Verusia Chetty
1Pietermaritzburg Burn Service, Pietermaritzburg Metropolitan Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; and, Developing Research, Innovation, Localization and Leadership (DRILL), College of Health Sciences, University of KwaZulu-Natal, Durban. shelley_wall@hotmail.com.
Insights
Experts reached consensus on a new burn pain management protocol for children in low-resource settings. This essential analgesia protocol addresses critical needs in resource-limited African countries.
Area of Science:
- Global Health
- Emergency Medicine
- Pain Management
Background:
- Burns pose a significant health burden in low- and middle-income countries (LMICs).
- Adequate pain management is crucial in burn care, yet protocols are lacking in resource-scarce settings.
- This highlights the need for developing adaptable analgesia protocols for LMICs.
Purpose of the Study:
- To achieve expert consensus on an analgesia protocol for pediatric burn patients in resource-limited settings.
- To develop a practical and effective pain management strategy for burn injuries in Africa.
- To establish a robust protocol through expert agreement.
Main Methods:
- A modified Delphi study involving nine experts in burn injury management from African LMICs.
- A two-round Delphi survey was employed to gather expert opinions.
- Consensus was defined as an 80% agreement threshold for protocol inclusion.
Main Results:
- Overarching agreement was achieved on the background analgesia protocol.
- Strong consensus was reached on using ketamine and midazolam for procedural sedation.
- The study successfully identified key components for a resource-limited analgesia protocol.
Conclusions:
- Expert consensus was obtained for a pediatric burn analgesia protocol in resource-limited settings using a modified Delphi method.
- The expert-driven consensus ensures the rigor and robustness of the developed protocol.
- Delphi methodology is valuable for healthcare research, facilitating convergence of expert opinions.
Background:
Despite the exceptional burden of burns in low- and middle-income countries (LMIC) and the importance of adequate analgesia in burn care, there is a lack of analgesia protocol developed in resource-scarce settings. This necessitates the development of an analgesia protocol applicable to the resource-scarce setting. This study presents the findings of a modified Delphi study aimed at achieving consensus by a panel of experts in the management of burn injuries from low- and middle-income settings across Africa.
Methods:
A two-round Delphi survey was conducted to achieve consensus on an analgesia protocol for paediatric burn patients for a resource-limited setting. The Delphi panel consisted of nine experts with experience in management of burn injuries in low-income settings.
Results:
Consensus was determined by an a priori threshold of 80% of agreement for a drug to be included in the analgesia protocol. There was a largely overarching agreement with regard to the background analgesia protocol and strong agreement regarding the use of an initial dose of ketamine and midazolam for procedural sedation.
Conclusion:
A modified Delphi method was used to obtain expert consensus for a recently adopted analgesia protocol for burn-injured children in a resource-limited setting, with experts in the management of burn injuries in low- and middle-income settings. The expert consensus leads to the rigour and robustness of the protocol. Delphi methods are exceptionally valuable in healthcare research and the aim of such studies is to find converging expert opinions.
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