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Assessment and Treatment of Pain in Hospitalized Children at a Tertiary Children's Hospital: A Cross-Sectional Mixed
Nadia Roessler De Angulo1, Andrea C Postier1, Lisa Purser1
1Stad Center for Pediatric Pain, Palliative & Integrative Medicine, Benioff Children's Hospital, Department of Pediatrics, University of California San Francisco, 1855 Fourth St., 4th Floor, San Francisco, CA 94158, USA.
Insights
Hospitalized children often experience under-treated acute pain. This study found pain assessment gaps and underutilization of multimodal and integrative pain treatments, especially for procedures.
Area of Science:
- Pediatric Pain Management
- Hospital Quality Improvement
- Clinical Documentation Standards
Background:
- Acute pain in hospitalized children is frequently under-recognized and undertreated.
- Effective pain management is crucial for pediatric patient outcomes and recovery.
Purpose of the Study:
- To benchmark pain assessment, documentation, treatment, and patient experience in hospitalized children.
- Identify gaps in current pediatric pain management practices.
Main Methods:
- Cross-sectional, mixed-method survey of hospitalized children (≥24 hours).
- Chart review for pain assessment and treatment modalities.
- Patient/caregiver surveys on pain management experience.
Main Results:
- All patients had pain scores documented, but gaps in assessment and documentation were noted.
- Moderate-to-severe pain scores were common (74.5%) among those with documented pain.
- Multimodal treatments, including medications (51.4%) and integrative modalities (36.4%), were underutilized; procedures frequently caused under-treated pain.
Conclusions:
- While pain scores were documented, significant gaps in care persist.
- Underutilization of multimodal and integrative pain interventions requires attention.
- Painful procedures are a key area for improvement, necessitating quality improvement initiatives.
Abstract:
(1) Background: Acute pain in hospitalized children remains under-recognized and under-treated. Our objective is to benchmark pain assessment, documentation, treatment, and patient experience in children admitted to a US children's hospital. (2) Methods: A cross-sectional, mixed-method survey of pain for children hospitalized ≥24 h. Charts were reviewed for modalities of pain assessment and treatment for all inpatients. If pain was documented, patients/caregivers were surveyed regarding their experience with pain and its management. (3) Results: Chart review: All 107 patients had ≥1 pain score documented. A total of 47 patients had a pain score ≥0, 35 (74.5%) of whom had ≥1 moderate-severe score. Seventy (65.4%) patients received ≥1 intervention for pain, including medications from ≥1 class (e.g., opioids) (n = 55, 51.4%) and/or integrative/non-pharmacologic intervention(s) (n = 39, 36.4%). There were assessment and documentation gaps. Patient survey: A total of 39 (83.0%) interviews were attempted; 25 (53.2%) were completed. The worst pain was mostly caused by acute illness (n = 13, 52%) and painful procedures (n = 10, 40%). Suggestions for improvement included increasing the use of integrative modalities and optimizing patient-clinician communication. (4) Conclusions: All patients admitted ≥24 h had ≥1 pain score documented; however, gaps in documentation were common. Multimodal treatment and integrative modalities were underutilized. Procedures were a frequent cause of under-treated pain, prompting an institution-wide quality improvement project.
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