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Procedural pain in a paediatric surgical emergency unit
1Department of Paediatric Anaesthesia and Intensive Care, Karolinska Hospital, St. Göran, Stockholm, Sweden.
Insights
Pediatric procedural pain in emergency settings is unacceptably high. Children perceive more pain than parents or nurses, highlighting a gap in pain management understanding and treatment.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Child Health
Background:
- Procedural pain in children is a significant concern in pediatric emergency departments.
- Current pain assessment methods may not fully capture the child's experience.
- Effective pain management strategies are crucial for pediatric patients undergoing procedures.
Purpose of the Study:
- To assess pain experienced by children during procedures in a pediatric surgical emergency department.
- To compare pain ratings between children, parents, and nurses.
- To identify factors influencing pain perception and management.
Main Methods:
- Utilized Visual Analogue Scale (VAS) for children over 10 and Smiley Five-Face Scale for children aged 3-9.
- Collected data from nurses, parents, and children regarding pain, medication, and behavior.
- Assessed specific procedures like balanitis irrigation, fracture treatment, and paronychia treatment for pain levels.
Main Results:
- Irrigation of glans penis, fracture treatment, and paronychia were identified as most painful procedures.
- 44% of children cried, 16% fought restraint, and 24% exhibited panic during procedures.
- Children reported higher pain scores than parents and nurses, with poor correlation between their estimates.
Conclusions:
- Pain experienced during pediatric emergency procedures is unacceptably high.
- Discrepancies exist between children's, parents', and nurses' pain assessments.
- Parents require better information on pain treatment options; children need access to advanced pain management.
Abstract:
Pain induced by various types of procedures was assessed in the Paediatric Surgical Emergency Department at St Göran's Children's Hospital in Stockholm. Assessments of pain were obtained from the nurse, the parent, and children over 10 years of age by means of a visual analogue scale. In children aged 3-9 years, the Smiley Five-Face Scale was used. The nurse and the parent also answered questionnaires about analgesic medication, the child's behaviour, and the parent's overall opinion of the pain management, etc. Irrigation of the glans penis because of balanitis, treatment of fractures and paronychia were considered to be the most painful procedures. Forty-four per cent of the children cried during the procedure and 16% fought against being restrained. In 24% of the cases, the child was judged to be in a state of "panic". In conclusion, we believe that the pain induced by procedures in the emergency rooms is unacceptably high. Children estimate higher pain scores than parents and nurses do. There was a poor correlation between the parent's and child's estimates of pain. Parents are not well informed about the possibilities for pain treatment. Infants and children attending emergency rooms must also benefit from recent advances in the treatment of pain.