Assessment of pain and adequacy of pain management in the pediatric emergency settings

Abstract

Introduction: IASP defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Over the last decades, great progress was made in pediatric pain evaluation and pain management. However, acute as well as chronic pain remains one of the most misunderstood, under-diagnosed and under-treated medical problems, particularly in children. Aims: To investigate accuracy of acute pain assessment and management in Pediatric Emergency Department in Hospital of Lithuania University of Health Sciences Kaunas Clinics. Methods: A quantitative retrospective cohort study. A total of 1000 outpatient cards were analyzed. Age, origin of pain (trauma or disease related), pain characteristics, pain medication (calculated pro kg), pain score and its dynamics after painkiller were collected. Randomly selected cases were divided into two groups as following: group A—patient records from 2017, group B—patient records of 2018. Patients with chronic diseases, chronic pain cases, hospitalized patients or treatment refusal were excluded from the study. Additionally, patients in each group were divided into: trauma and non-trauma patients and subdivided into four different age groups. Statistical analysis was performed using Microsoft Excel and IBM SPSS Statistics version 21.0 software for Windows. Descriptive statistical methods were applied, Kolmogorov–Smirnov test, T criterion for calculating pairs of samples, Mann–Whitney U test and Chi-square test. A p value of <0.05 was considered significant. Results: We compared 500 pain cases per group A and B. There were 154 (30.8%) traumatic patients in group A versus 116 traumatic patients in group B (23.2%). Pain scoring was performed in 420 (84%) children in group A and it was statistically significantly less than in group B (94.4% of all 500 cases, p < 0.001). Moreover, in all age groups of g[...].