Prospective observational study on pain identification and management in a pediatric hospital-at-home unit

Pain assessment is an essential component of the evaluation of pediatric patients. In the context of home hospitalization, pain management poses a clinical challenge, as it requires active participation from caregivers and must be supported by adequate training. The main objective of this study was to describe the identification, assessment, and management of pain in a hospital-at-home unit after the implementation of a protocol.

We conducted a prospective, observational, and descriptive study following the implementation of a pain management protocol. The sample included all patients admitted to the unit. The following variables were assessed: the ability of the caregiver to identify and manage pain, and the approach to pain management during painful procedures performed at home.

The study included a total of 309 care episodes corresponding to 198 patients. Pain was adequately documented in 264 cases (85.4%). We found near-perfect agreement between caregiver- and provider-reported pain assessments (κ = 0.96; P < .001). Pain was identified in 31 procedures (10.0%). The median length of stay was significantly longer among patients with pain compared to those without pain (8 days [IQR, 5-13] vs 4 days [IQR, 2-5]; P < .01). Only three patients (1%) required hospital readmission due to poor pain control. A total of 32 painful procedures were performed, and some type of analgesic strategy was used in all of them: nonpharmacological measures in 12 patients and topical analgesia combined with nonpharmacological strategies in 19.

Pediatric pain management at home appears feasible and effective through structured protocols that include caregiver participation and appropriate training. The high compliance rate and minimal discrepancy between caregiver and health care staff assessments suggest that the model is safe and well-accepted by both caregivers and professionals.