A service evaluation of paediatric pain management in an English ambulance service

Pilbery, Richard; Miles, Jamie; Bell, Fiona

doi:10.29045/14784726.2019.09.4.2.37

Cited by 7 publications

(9 citation statements)

References 13 publications

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“…Non-pharmacological interventions such as slings, splints, bandages and dressings are often missing from datasets or not extracted for analysis and are subsequently cited as a limitation in published research (Lord et al, 2016;Murphy et al, 2017). Other non-pharmacological approaches such as distraction, staying close to relatives and creating a calm environment are rarely documented or extracted for analysis (Pilbery et al, 2019). This lack of data, coupled with the complexity of pre-hospital pain management in children (Whitley et al, 2019), causes uncertainty when attempting to improve quality of care for children suffering from pain.…”

Section: Introductionmentioning

confidence: 99%

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

Whitley

Hemingway

Law

et al. 2020

J Child Health Care

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We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: ‘child sex (male)’, ‘child age (younger)’, ‘type of pain (traumatic)’ and ‘analgesic administration’. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child’s experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration: PROSPERO CRD42017058960

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Section: Introductionmentioning

confidence: 99%

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

Whitley

Hemingway

Law

et al. 2020

J Child Health Care

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“…In a study by Hewes et al, 19.9% of all patients with documented post-traumatic pain received analgesics [ 21 ]. Even patients with severe pain (VNRS 8–10) do not always receive any analgesia—the Lord et al study showed 55% were untreated children and the Pilbery et al study showed 87% [ 17 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Pre-Hospital Pain Management in Children with Injuries: A Retrospective Cohort Study

Holak¹,

Czapla

Zielińska

2021

JCM

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Background: The all-too-frequent failure to rate pain intensity, resulting in the lack of or inadequacy of pain management, has long ceased to be an exclusive problem of the young patient, becoming a major public health concern. This study aimed to evaluate the methods used for reducing post-traumatic pain in children and the frequency of use of such methods. Additionally, the methods of pain assessment and the frequency of their application in this age group were analysed. Methods: A retrospective analysis of 2452 medical records of emergency medical teams dispatched to injured children aged 0–18 years in the area around Warsaw (Poland). Results: Of all injured children, 1% (20 out of 2432) had their pain intensity rated, and the only tool used for this assessment was the numeric rating scale (NRS). Children with burns most frequently received a single analgesic drug or cooling (56.2%), whereas the least frequently used method was multimodal treatment combining pharmacotherapy and cooling (13.5%). Toddlers constituted the largest percentage of patients who were provided with cooling (12%). Immobilisation was most commonly used in adolescents (29%) and school-age children (n = 186; 24%). Conclusions: Low frequency of pain assessment emphasises the need to provide better training in the use of various pain rating scales and protocols. What is more, non-pharmacological methods (cooling and immobilisation) used for reducing pain in injured children still remain underutilized.

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“…Previous studies of children in prehospital care show that although the pain was documented in the ambulance records, the level of pain was not assessed in 66–96% of cases [ 5 , 7 ]. Previous findings also show that 52–88% of children in prehospital setups did not receive pain medication despite having moderate to severe pain [ 5 , 8 ]. The most common reasons for not providing adequate pain medication to children in prehospital settings include fearing side effects, difficulties with intravenous (IV) line access, being under five years of age, the lack of a pain assessment and the assumption that children need less analgesia than adults [ 9 – 12 ].…”

Section: Introductionmentioning

confidence: 97%

The effectiveness and safety of paediatric prehospital pain management: a systematic review

Abebe

Hetmann

Sumera

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Clinically meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not received sufficient attention. The present systematic review therefore aims to perform a comprehensive search of databases to examine the preferable drugs for prehospital pain relief in paediatric patients with acute pain, irrespective of aetiology. Methods The systematic review includes studies from 2000 and up to 2020 that focus on children’s prehospital pain management. The study protocol is registered in PROSPERO with registration no. CRD42019126699. Pharmacological pain management using any type of analgesic drug and in all routes of administration was included. The main outcomes were (1) measurable pain reduction (effectiveness) and (2) no occurrence of any serious adverse events. Searches were conducted in PubMed, Medline, Embase, CINAHL, Epistemonikos and Cochrane library. Finally, the risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist and a textual narrative analysis was performed due to the heterogeneity of the results. Results The present systematic review on the effectiveness and safety of analgesic drugs in prehospital pain relief in children identified a total of eight articles. Most of the articles reviewed identified analgesic drugs such as fentanyl (intranasal/IV), morphine (IV), methoxyflurane (inhalational) and ketamine (IV/IM). The effects of fentanyl, morphine and methoxyflurane were examined and all of the included analgesic drugs were evaluated as effective. Adverse events of fentanyl, methoxyflurane and ketamine were also reported, although none of these were considered serious. Conclusion The systematic review revealed that fentanyl, morphine, methoxyflurane and combination drugs are effective analgesic drugs for children in prehospital settings. No serious adverse events were reported following the administration of fentanyl, methoxyflurane and ketamine. Intranasal fentanyl and inhalational methoxyflurane seem to be the preferred drugs for children in pre-hospital settings due to their ease of administration, similar effect and safety profile when compared to other analgesic drugs. However, the level of evidence (LOE) in the included studies was only three or four, and further studies are therefore necessary.

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A service evaluation of paediatric pain management in an English ambulance service

Cited by 7 publications

References 13 publications

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

Pre-Hospital Pain Management in Children with Injuries: A Retrospective Cohort Study

The effectiveness and safety of paediatric prehospital pain management: a systematic review

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