Nonpharmacologic Pediatric Pain Management in Emergency Departments: A Systematic Review of the Literature

Wente, Sarah

doi:10.1016/j.jen.2012.09.011

Cited by 79 publications

(47 citation statements)

References 30 publications

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“…studies suggest that music and other modalities may be a valuable adjunct to treat pain in the ED, 35,36 but definitive evidence is lacking, as is a deeper understanding of parental reasons for utilizing (or not utilizing) these modalities. Further exploration of nonpharmacologic therapies is merited, as they may prove to be minimally invasive, cost-effective ways to improve children's pain and anxiety.…”

Section: (16) 93mentioning

confidence: 99%

A Survey of Caregiver Perspectives on Children’s Pain Management in the Emergency Department

Ali

Weingarten

Kircher

et al. 2015

CJEM

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Objectives: We explored caregiver perspectives on their children's pain management in both a pediatric (PED) and general emergency department (GED). Study objectives were to: (1) measure caregiver estimates of children's pain scores and treatment; (2) determine caregiver level of satisfaction; and (3) determine factors associated with caregiver satisfaction. Methods: This prospective survey examined a convenience sample of 97 caregivers (n = 51 PED, n = 46 GED) with children aged <17 years. A paper-based survey was distributed by research assistants, from 2009-2011. Results: Most caregivers were female (n = 77, 79%) and were the child's mother (n = 69, 71%). Children were treated primarily for musculoskeletal pain (n = 41, 42%), headache (n = 16, 16%) and abdominal pain (n = 7, 7%). Using a 100 mm Visual Analog Scale, the maximum mean reported pain score was 75 mm (95% CI: 70-80) and mean score at discharge was 39 mm (95% CI: 32-46). Ninety percent of caregiver respondents were satisfied (80/89, 90%); three (3/50, 6%) were dissatisfied in the PED and six (6/39, 15%) in the GED. Caregivers who rated their child's pain at ED discharge as severe were less likely to be satisfied than those who rated their child's pain as mild or moderate (p = 0.034). Conclusions: Despite continued pain upon discharge, most caregivers report being satisfied with their child's pain management. Caregiver satisfaction is likely multifactorial, and physicians should be careful not to interpret satisfaction as equivalent to adequate provision of analgesia. The relationship between satisfaction and pain merits further exploration. RÉSUMÉObjectifs: L'étude a porté sur le point de vue des aidants quant à la prise en charge de la douleur chez les enfants dans un service des urgences pédiatriques (SUP) et dans un service des urgences générales (SUG). L'étude visait à: 1) mesurer l'intensité de la douleur chez les enfants, estimée par les aidants ainsi que le traitement appliqué; 2) déterminer le degré de satisfaction des aidants; et 3) déterminer les facteurs associés à la satisfaction des aidants. Méthode: Il s'agit d'une enquête prospective, menée dans un échantillon de commodité de 97 aidants (SUP: n = 51; SUG: n = 46) qui accompagnaient des enfants de moins de 17 ans. Des questionnaires d'enquête sur papier ont été distribués par des assistants de recherche, de 2009 à 2011. Résultats: La plupart des aidants étaient des femmes (n = 77; 79 %) et, bien souvent, la mère des enfants (n = 69; 71 %). Les enfants étaient traités surtout pour des douleurs musculosquelettiques (n = 41; 42 %), des céphalées (n = 16; 16 %) et des douleurs abdominales (n = 7; 7 %). Le score maximal moyen, indiqué sur une échelle visuelle analogue de 100 mm s'élevait à 75 mm (IC à 95 %: 70-80) et le score moyen au moment du congé était de 39 mm (IC à 95 %: 32-46). Quatrevingt-dix pour cent des aidants qui ont répondu à l'enquête se sont dits satisfaits (n = 80/89; 90 %); 3 (n = 3/50; 6 %) au SUP et 6 (n = 6/39; 15 %) au SUG ne l'étaient pas. Les aidants qui ont ...

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Section: (16) 93mentioning

confidence: 99%

A Survey of Caregiver Perspectives on Children’s Pain Management in the Emergency Department

Ali

Weingarten

Kircher

et al. 2015

CJEM

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“…Although several data show that analgesia does not mask signs of acute abdominal diseases, nurses still avoid the prompttreatment of abdominal pain. Although non-pharmacological interventions, such as distraction, positioning, sucrose, have been described to be useful in reducing abdominal pain [4] they are often unsatisfactory. In conclusion, we suggest that educational interventions and staff trainings should be addressed to promote children’s pain alleviation at triage.…”

Section: Discussionmentioning

confidence: 99%

Promoting children’s pain alleviation in emergency department

Cantoni

2014

Ital J Pediatr

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“…Furthermore, an RCT concluded that the sitting position on the parent's lap reduced distress for children aged 9 months to 4 years and improved the parent's satisfaction without increasing the number of attempts required to obtain intravenous access [88]. These results are reported in a systematic review [89]. For intravenous insertion, a child in a sitting position held by his/her parent is thought to experience reduced fear, and the position is reported to reduce the child's body movements and improve work space [90].…”

Section: Non-pharmacological Management Strategiesmentioning

confidence: 94%

Managing Pediatric Pain in the Emergency Department

Bailey

Trottier

2016

Pediatr Drugs

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Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.

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Nonpharmacologic Pediatric Pain Management in Emergency Departments: A Systematic Review of the Literature

Cited by 79 publications

References 30 publications

A Survey of Caregiver Perspectives on Children’s Pain Management in the Emergency Department

A Survey of Caregiver Perspectives on Children’s Pain Management in the Emergency Department

Promoting children’s pain alleviation in emergency department

Managing Pediatric Pain in the Emergency Department

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