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Reducing pain through distraction therapy in small acute paediatric burns
1Department of Burns, Plastic and Reconstructive Surgery, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol BS2 8BJ, United Kingdom.
Insights
Distraction therapy significantly reduced pain scores in children with small burns during outpatient assessment. Specialist distraction therapy lowered peak pain by over 2 points on the Wong-Baker™ VAS, improving the child
Area of Science:
- Pediatric Burn Care
- Pain Management in Children
- Therapeutic Interventions
Background:
- Small burns in children are frequently managed in outpatient settings.
- Burn assessment can be a distressing experience for pediatric patients.
- Distraction therapy is a potential non-pharmacological adjunct to minimize distress.
Purpose of the Study:
- To investigate the efficacy of distraction therapy in reducing objective pain scores.
- To assess pain during outpatient assessment of small acute burns in children.
Main Methods:
- Two groups of pediatric patients with small burns were studied.
- Group A received standard analgesia and nursing care; Group B received additional specialist distraction therapy.
- Pain was measured using the Wong-Baker™ visual analogue scale (VAS) at three intervals.
Main Results:
- A total of 50 patients were recruited (32 in Group A, 18 in Group B).
- Distraction therapy significantly reduced mean pain scores at the start (0.33 vs 1.55) and peak (4.47 vs 6.80) of the consultation.
- Higher total body surface area (TBSA) burns correlated with increased pain scores (p < 0.05).
Conclusions:
- Specialist distraction therapy can decrease maximal pain by over 2 points on the Wong-Baker™ VAS.
- Distraction therapy is an effective method for managing pain in pediatric burn patients.
- Availability of distraction therapy should be ensured during initial consultations for pediatric burn injuries.
Introduction:
The majority of patients who sustained small (low % total body surface area [TBSA]) burns are assessed in an outpatient setting. This can be a traumatic experience, particularly, for paediatric patients. During the initial assessment pharmacological and non-pharmacological adjuncts, such as distraction therapy, can be employed to provide an environment that may reduce and minimise distress. In this study, we investigated whether distraction therapy reduces objective pain scores during the outpatient assessment of small acute burns in children.
Methods:
Two cohorts of patients were formed. In the first group (group A), the children received analgesia and routine nursing care. In the second group (group B), the children received specialist distraction therapy in addition to the same analgesia and nursing care. We recorded patient demographics, TBSA, anatomical sites and mechanism of burn. The Wong Baker™ visual analogue scale (VAS) was used to convert perceived pain, as reported by the patient or parent, into a numerical value at three set intervals during the consultation.
Results:
50 patients were recruited with 32 patients in group A and 18 in group B. A larger TBSA positively correlated with higher pain scores (p < 0.05). At the start of the consultation the mean pain score without distraction therapy was 1.55 and with specialist distraction therapy was 0.33 (p < 0.05). The mean peak pain score during dressing change without distraction therapy was 6.80 and with specialist distraction was 4.47 (p < 0.05). At the end of the procedure, the mean pain score was 2.12 without distraction therapy and with specialist distraction 1.75.
Conclusion:
This study of pain scores in small acute paediatric burns has shown that distraction therapy provided by a qualified play specialist can reduce maximal pain by over 2 points on the Wong-Baker™ VAS. Consideration should be given to ensure that distraction therapy is available at all times during initial consultations for children who have sustained small burns.
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