Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals

BMC Pediatrics

Franca Benini¹  Simone Piga⁵  Valentina Losacco⁵  Nicola Pirozzi⁴  Gianni Messi²  Caterina Tomasello⁴  Tiziana Zangardi³  Marina Cuttini⁵  Pierpaolo Ferrante⁵ 

[1] Pediatric Department, University Hospital, Padova, Italy;Department of Emergency Medicine, Burlo Garofolo Children’s Hospital, Trieste, Italy;Department of Emergency Medicine, University Hospital, Padova, Italy;Department of Emergency Medicine, Bambino Gesù Children’s Hospital, Rome, Italy;Unit of Epidemiology, Bambino Gesù Children’s Hospital, Viale Ferdinando Baldelli 41, Rome 00146, Italy

关键词: Policies;    Emergency care;    Algometric scales;    Pediatric pain management;   

Others  :  1144530
DOI  :  10.1186/1471-2431-13-139

 received in 2013-03-12, accepted in 2013-09-05,  发布年份 2013

【 摘 要 】

Background

Pain experienced by children in emergency departments (EDs) is often poorly assessed and treated. Although local protocols and strategies are important to ensure appropriate staff behaviours, few studies have focussed on pain management policies at hospital or department level. This study aimed at describing the policies and reported practices of pain assessment and treatment in a national sample of Italian pediatric EDs, and identifying the assocoated structural and organisational factors.

Methods

A structured questionnaire was mailed to all the 14 Italian pediatric and maternal and child hospitals and to 5 general hospitals with separate pediatric emergency room. There were no refusals. Information collected included the frequency and mode of pain assessment, presence of written pain management protocols, use of local anaesthetic (EMLA cream) before venipuncture, and role of parents. General data on the hospital and ED were also recorded. Multiple Correspondence Analysis was used to explore the multivariable associations between the characteristics of hospitals and EDs and their pain management policies and practices.

Results

Routine pain assessment both at triage and in the emergency room was carried out only by 26% of surveyed EDs. About one third did not use algometric scales, and almost half (47.4%) did not have local protocols for pain treatment. Only 3 routinely reassessed pain after treatment, and only 2 used EMLA. All EDs allowed parents’ presence and most (17, 89.9%) allowed them to stay when painful procedures were carried out. Eleven hospitals (57.9%) allowed parents to hold their child during blood sampling. Pediatric and maternal and child hospitals, those located in the North of Italy, equipped with medico-surgical-traumatological ED and short stay observation, and providing full assessment triage over 24 hours were more likely to report appropriate policies for pain management both at triage and in ER. A nurses to admissions ratio ≥ median was associated with better pain management at triage.

Conclusions

Despite availability of national and international guidelines, pediatric pain management is still sub-optimal in Italian emergency departments. Multifaceted strategies including development of local policies, staff educational programs, and parental involvement in pain assessment should be carried out and periodically reinforced.

【 授权许可】

   
2013 Ferrante et al.; licensee BioMed Central Ltd.

【 图 表 】

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