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Characterizing the Pain Experience of Children With Acute Gastroenteritis Based on Identified Pathogens
Keon Ma1, Samina Ali2,3, Jianling Xie4
1From the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Insights
Children with acute gastroenteritis (AGE) experience significant pain. Bacterial infections were associated with higher pain scores, but older age and fever were stronger influences on pain severity.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pain Management
Background:
- Acute gastroenteritis (AGE) is a common childhood illness often accompanied by significant pain.
- The relationship between specific enteropathogens and pain severity in pediatric AGE is not well understood.
Purpose of the Study:
- To investigate the correlation between pain severity and specific enteropathogens in children diagnosed with AGE.
- To identify factors influencing pain severity in pediatric AGE.
Main Methods:
- Prospective recruitment of 2686 children with AGE across two pediatric emergency departments.
- Pain severity was measured using the 11-point Verbal Numerical Rating Scale by children and/or caregivers.
- Enteropathogen detection was performed on stool samples; multivariable modeling was used to analyze influencing factors.
Main Results:
- Mean highest pain scores were 5.5 (prior to ED visit) and 4.2 (in ED).
- Bacterial enteropathogen detection was associated with higher mean pain scores (6.6 prior to ED) compared to single virus (5.5) or negative tests (5.5).
- Older age, fever, illness duration, vomiting/diarrhea frequency, and respiratory symptoms were associated with greater pain severity, not pathogen type.
Conclusions:
- Children with AGE experience considerable pain, with bacterial enteric pathogens potentially exacerbating it.
- However, factors such as older age and fever appear to be more significant determinants of pain severity than the specific enteropathogen identified.
Objectives:
Pain is common with acute gastroenteritis (AGE) yet little is known about the severity associated with specific enteropathogens. We sought to explore the correlation of pain severity with specific enteropathogens in children with AGE.
Methods:
Participants were prospectively recruited by the Alberta Provincial Pediatric EnTeric Infection TEam at 2 pediatric emergency departments (EDs) (December 2014-August 2018). Pain was measured (by child and/or caregiver) using the 11-point Verbal Numerical Rating Scale.
Results:
We recruited 2686 participants; 46.8% (n = 1256) females, with median age 20.1 months (interquartile range 10.3, 45.3). The mean highest pain scores were 5.5 [standard deviation (SD) 3.0] and 4.2 (SD 2.9) in the 24 hours preceding the ED visit, and in the ED, respectively. Prior to ED visit, the mean highest pain scores with bacterial detection were 6.6 (SD 2.5), compared to 5.5 (SD 2.9) for single virus and 5.5 (SD 3.1) for negative stool tests. In the ED, the mean highest pain scores with bacterial detection were 5.5 (SD 2.7), compared to 4.1 (SD 2.9) for single virus and 4.2 (SD 3.0) for negative stool tests. Using multivariable modeling, factors associated with greater pain severity prior to ED visit included older age, fever, illness duration, number of diarrheal or vomiting episodes in the preceding 24 hours, and respiratory symptoms, but not enteropathogen type.
Conclusion:
Children with AGE experience significant pain, particularly when the episode is associated with the presence of a bacterial enteric pathogen. However, older age and fever appear to influence children's pain experiences more than etiologic pathogens.
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