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improving Pain mAnagement for childreN and young people attendeD by Ambulance (PANDA): protocol for a realist review
Georgie Nicholls1, Georgette Eaton2,3, Marishona Ortega4
1Community and Health Research Unit, University of Lincoln, Lincoln, England, LN6 7FS, UK.
Insights
Prehospital pain management for children and young people (CYP) is often ineffective, impacting their long-term health. This realist review explores how ambulance clinicians can improve acute pain relief for CYP in emergency situations.
Area of Science:
- Emergency medicine
- Pediatric care
- Pain management
Background:
- Annually, 450,000 children and young people (CYP) in England visit emergency departments via ambulance.
- Approximately 20% of these CYP experience acute pain due to illness or injury.
- Current prehospital pain management for CYP is inadequate, with 61% not achieving effective pain relief.
Purpose of the Study:
- To understand how ambulance clinicians can improve prehospital acute pain management for CYP.
- To identify factors influencing the effectiveness of pain relief in pediatric emergency care.
- To inform strategies for better pain management in prehospital settings.
Main Methods:
- A realist review will be conducted following RAMESES guidance.
- The review involves developing an Initial Programme Theory (IPT), comprehensive searching, data extraction, and synthesis.
- Realist logic will be used to generate and refine context-mechanism-outcome configurations (CMOCs).
Main Results:
- This section is to be filled after the review is completed.
Conclusions:
- The refined realist Programme Theory (PT) will enhance understanding of effective prehospital pain management for CYP.
- Findings will inform future realist evaluations to improve care for pediatric patients experiencing acute pain.
Background:
Each year in England, 450,000 children and young people (CYP) under 18 years of age are transported by ambulance to emergency departments. Approximately 20% of these suffer acute pain caused by illness or injury. Pain is a highly complex sensory and emotional experience. The intersection between acute pain, unwell CYP and the unpredictable pre-hospital environment is convoluted. Studies have shown that prehospital pain management in CYP is poor, with 61% of those suffering acute pain not achieving effective pain relief (abolition or reduction of pain score by 2 or more out of 10) when attended by ambulance. Consequences of poor acute pain management include altered pain perception, post-traumatic stress disorder and the development of chronic pain. This realist review will aim to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP.
Methods:
A realist review will be conducted in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. A five-stage approach will be adopted; 1) Developing an Initial Programme Theory (IPT): develop an IPT with key stakeholder input and evidence from informal searching; 2) Searching and screening: conduct a thorough search of relevant research databases and other literature sources and perform screening in duplicate; 3) Relevance and rigour assessment: assess documents for relevance and rigour in duplicate; 4) Extracting and organising data: code relevant data into conceptual "buckets" using qualitative data analysis software; and 5) Synthesis and Programme Theory (PT) refinement: utilise a realist logic of analysis to generate context-mechanism-outcome configurations (CMOCs) within and across conceptual "buckets", test and refine the IPT into a realist PT.
Conclusion:
The realist PT will enhance our understanding of what works best to improve acute prehospital pain management in CYP, which will then be tested and refined within a realist evaluation.
Registration:
PROSPERO Registration: CRD42024505978.
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