Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments

Abstract

Background: In the emergency department (ED), adequate pain control is essential for managing patients; however, children with pain are known to receive less analgesia than adults with pain. We introduce the Pain Passport to improve pain management in paediatric patients with suspected fractures in the ED. Methods: This was a before-and-after study. We reviewed the medical records of paediatric patients who were primarily diagnosed with fractures from May to August 2015. After the introduction of the Pain Passport, eligible children were enrolled from May to August 2016. Demographics, analgesic administration rates, time intervals between ED arrival and analgesic administration, and satisfaction scores were obtained. We compared the analgesic prescription rate between the two periods using multiple logistic regression. Results: A total of 58 patients were analysed. The baseline characteristics of subjects during the two periods were not significantly different. Before the introduction of the Pain Passport, 9 children (31.0%) were given analgesics, while after the introduction of the Pain Passport, a significantly higher percentage of patients (24/29, 82.8%) were treated with analgesics (P < 0.001). The median administration times were 112 (interquartile range [IQR], 64-150) minutes in the pre-intervention period and 24 (IQR, 20-74) minutes in the post-intervention period. The median satisfaction score for the post-intervention period was 4 (IQR, 3-5). The adjusted odds ratio for providing analgesics in the post-intervention period was 25.91 (95% confidence interval, 4.36-154.02). Conclusions: Patient-centred pain scoring with the Pain Passport improved pain management in patients with suspected fractures in the paediatric ED.

Predictive Value of the Phase Angle for Analgesic Efficacy in Lumbosacral Transforaminal Block

“…However, objective metrics for assessing pain relief have not been well evaluated. Commonly used self-reported pain questionnaires are based on patient subjective responses, which may be affected by various factors, such as comorbid conditions and/or psychosocial causes [ 6 , 7 , 8 ]. Several objective pain tools, including skin conductance, nociception index, and pupillometry, have been reported; however, they involve high costs, limited availability, invasiveness, and/or various levels of accuracy [ 9 ].…”