Different wound management techniques influence for children and parents emotional state and level of pain

Abstract

Objectives. Lacerations are one of the most common reasons why parents bring their children into paediatric emergency department (PED). Many physicians use old but reliable wound closing practices (i.e. suturing) and avoid new non-invasive methods (i.e. tissue adhesive, Steri-strips) which can be less painful and stressful for children and their parents. Our aim was to compare the emotional state (fear/anxiety) of children and parents, the level of pain before and after procedure, using different wound management techniques. Materials and Methods. Parents who accompany their injured children to University Hospital Kaunas Klinikos PED filled a 2-part questionnaire before and after the procedure (laceration repair). Pain and emotional state (fear/anxiety) were evaluated by VAS-10 (visual analogue scale 1 – no impact, 10 – bad impact). Results. 160 questionnaires were collected. Only 101 were further analyzed. The average age of children was 6.81 (min – 11 months, max – 16 years). Suturing was used more frequently for older children. Non-invasive methods were prioritized for younger ones. Parents noted that child’s pain decreased after all procedures (p<0.05). Less pain was indicated during laceration repair with Steri-strip (VAS before –4.19, during –2.11, after - 1.08). A statistically significant pain decrease was seen after suturing and Steri-strip, but fear and anxiety were way higher in suturing group before procedure (p<0.004) comparing with tissue adhesives (p=0.005) or Steri-strip (p=0.03). Parents indicated that they feared more if their child received suturing compared to Steri-strip method (p<0.05). We did not notice a difference in the level of anxiety between mothers and fathers (p<0.05). Conclusions. Children and parents experienced less fear and anxiety with non-invasive wound closing methods which are less painful for paediatric patients.