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Prevalence and source of pain in pediatric inpatients
Elizabeth A Cummings1, Graham J Reid, Allen G Finley
1Pediatrics, IWK-Grace Health Centre, Halifax,Nova Scotia,Canada Psychology, IWK-Grace Health Centre and Dalhousie University,Halifax, Nova Scotia,Canada Anesthesia, IWK-Grace Health Centre and Dalhousie University,Halifax, Nova Scotia,Canada Nursing, IWK-Grace Health Centre and Dalhousie University,Halifax, Nova Scotia,Canada.
Insights
Many hospitalized children experience significant pain, often undertreated. Improved pain assessment and management, including medication and non-pharmacological approaches, are crucial for pediatric patients.
Area of Science:
- Pediatric Medicine
- Pain Management
- Epidemiology
Background:
- Limited understanding of pain prevalence and sources in hospitalized children.
- Pain is a common and significant issue in pediatric healthcare settings.
Purpose of the Study:
- To investigate the epidemiology of pain in a pediatric hospital.
- To identify sources of pain and assess pain management practices.
Main Methods:
- Epidemiological study involving interviews with children (≥5 years) and parents (<5 years).
- Data collected on pain intensity, source, help received, and prescribed/administered analgesics.
- Included 200 pediatric inpatients from a tertiary care hospital.
Main Results:
- 49% reported clinically significant worst pain; 21% reported significant usual pain.
- Pain causes included disease, surgery, and intravenous lines; intensity unrelated to demographics or patient type.
- Children received less prescribed medication than indicated, irrespective of pain levels.
Conclusions:
- Many children endure unacceptable pain levels during hospitalization.
- Aggressive pain prevention, assessment (like vital signs), and management are necessary.
- Improvements needed in analgesic prescribing/administration and non-pharmacological pain control.
Abstract:
Our knowledge of the prevalence and sources of pain within hospital is limited. The present study is an epidemiological investigation of pain in a pediatric hospital. All children who were inpatients in a tertiary care hospital (excluding Neonatal ICU and psychiatry patients) and one parent per child were potential subjects. Interviews were conducted on three weekdays. Parent interviews were used for children less than 5 years of age (n = 102); child interviews were used for children age 5 years and older (n = 98). Subjects reported the intensity and source of the worst, usual and current pain during the past 24 h, and help received for pain. Medical and demographic variables and analgesics prescribed and administered were obtained from the medical record. Forty-nine percent of subjects reported clinically significant levels of worst pain. Twenty-one percent of subjects had clinically significant levels of usual pain. Causes of pain were variable and included disease, surgery, and intravenous lines (I.V.). Pain intensity was not significantly related to age, gender, patient type (medical, surgical), or diagnostic category. Children were given significantly less medication than was prescribed, regardless of their reported pain level. Nurses, mothers, and 'no-one' were frequently reported as helping with pain. Medications and nonpharmacological methods were reported as helpful in managing pain. Many children endure unacceptable levels of pain during hospitalization. Pain prevention and management must be more aggressive. Pain assessment should be approached with the same attention as vital signs. Improvements in analgesic prescription and administration practices and non-pharmacological pain control methods are needed.