Pain Prevalence Among Children Visiting Pediatric Emergency Departments

Abstract

Objectives:The main purpose of this study was to investigate the prevalence, characteristics, and intensity of children's pain in emergency departments. The secondary purpose was to evaluate the interobserver agreement regarding the level of pain perceived by professionals, parents, and children.Methods: This was a multicenter, survey-based research study on 0-to 18-year-old patients visiting 1 of the 15 hospitals that form part of the Working Group on Analgesia and Sedation of the Spanish Society of Pediatric Emergency Medicine between October and December 2018. The surveys recorded pain presence, intensity, characteristics, and location. Results:The study included 1216 surveys. At the time of the interview, 646 patients were experiencing pain, a prevalence of 53.1% (95% confidence interval, 50.3%-55.9%), with 25.38% reporting mild, 36.68% moderate, and 37.46% intense pain. Among the patients, 29.9% had abdominal pain and 14.1% pain in their legs.The pain lasted less than 24 hours in 48.2% of the patients, whereas only 3.0% experienced pain during more than 15 days. The parents of 50.7% of the children had provided an analgesic at home.Interrater agreement regarding pain levels was k = 0.35 between professionals and children, k = 0.38 between children and parents, and k = 0.17 between parents and professionals. For children unable to cooperate, the agreement between professional/child and the parents was k = 0.11. Conclusions:Pain is a common symptom among emergency department patients, and its evaluation should therefore be obligatory. We found low interrater agreement on pain levels between patients, professionals, and parents, which confirms how difficult it is to accurately evaluate pain intensity.

The Effect of 2 Different Distraction Methods on Pain, Fear, and Anxiety Levels During Venous Blood Draw in Children in a Pediatric Emergency Unit

“…Watching cartoons with a tablet is an effective distraction method, and can reduce pain and fear by concentrating the child's attention on a stimulus other than pain, with both visual and auditory stimuli 7,8. Our findings are consistent with previous studies that showed children, with ages ranging from 3 to 12 years, who watched cartoons during blood draw procedures experienced less pain and fear 7,8,11,41,42. Similarly, Sönmez Düzkaya et al29 found that watching cartoons with a tablet during blood draws was efficient in decreasing the level of pain and anxiety in children 29.…”

“…7,8 Our findings are consistent with previous studies that showed children, with ages ranging from 3 to 12 years, who watched cartoons during blood draw procedures experienced less pain and fear. 7,8,11,41,42 Similarly, Sönmez Düzkaya et al 29 found that watching cartoons with a tablet during blood draws was efficient in decreasing the level of pain and anxiety in children. 29 Similar to the results of this study, literature shows that watching cartoons with a tablet during invasive intravascular procedures efficiently decreases pain, fear, and anxiety in children.…”

“…These strategies alleviate stress, fear, anxiety, and pain by directing the child's attention to another stimulation. [7][8][9] In the literature, watching cartoons, 10,11 listening to music, 12,13 or using the cough trick and balloon inflation, [14][15][16] animalassisted interventions, 17 kaleidoscope, 18 distraction cards, 16 and virtual reality (VR) [19][20][21] are mostly used as distraction methods to reduce negative perception and emotion during invasive intravascular procedures. 19 In recent years, VR has emerged as an innovative replacement for conventional exposure-based therapy for various illnesses.…”

Actions to Avoid in Pain Management and Sedoanalgesia Procedures in Pediatric Emergencies

“…A multicenter study developed in Spain describes a prevalence of 53.1% of the patients attended, being severe in 37.1%. 9 Inadequate pain management not only implies anxiety and discomfort in the patient, but also reduces patient collaboration, which can affect the care process. The evaluation of pain in the PED should therefore be systematic and use an appropriate methodology that allows the selection of the ideal drug to achieve maximum effectiveness in pain relief.…”

Simplified Scale for Assessing Behaviors Regarding “Ganbatta” Concept in Children Aged 3–7 Years Undergoing Blood Sampling and Vaccination

“…Notably, the effects of local anesthetics and nonpharmacological methods have been tested. Methods include distraction intervention [12][13][14][15][16][17], combined cognitive-behavioral therapy [18,19], hypnosis [20,21], preparation or information [22,23], breathing [24,25], and suggestions that a placebo cream might help the needle to hurt less [26]. Pain and distress are the primary outcomes when evaluating these nonpharmacological interventions, and their effectiveness is determined by reducing these two unpleasant feelings.…”