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

Abstract

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

Ambulance clinician perspectives of disparity in prehospital child pain management: A mixed methods study

“…Analgesic administration should be encouraged when indicated, even if the onset time is considered slow, as there are potentially psychosocial benefits in addition to the pharmaceutical effects. A recent systematic review also concluded that efforts to facilitate analgesic administration should take priority 44 . Ambulance services should aim to staff all vehicles with at least one paramedic, necessitating long‐term commitment to developing staff.…”

“…A recent systematic review also concluded that efforts to facilitate analgesic administration should take priority. 44 Ambulance services should aim to staff all vehicles with at least one paramedic, necessitating longterm commitment to developing staff. Clinicians should consider any unconscious (implicit) bias they may have by evaluating "gut" reactions to specific groups of patients and what impact this has on patient care.…”

Improving ambulance care for children suffering acute pain: a qualitative interview study

“…Only the interviewer and interviewee were present during the session. An interview schedule was used as a prompt and to collect field notes (see Additional file 1 ); the development of the interview schedule was informed by our previous systematic review [ 12 ] and the first phase of our mixed methods study [ 2 ]. The interview schedule was pilot tested on the first three participants; no substantial changes were required.…”

“…A recent systematic mixed studies review identified and synthesised five qualitative studies assessing the barriers and facilitators to pre-hospital pain management in children [ 12 ]. There were no studies that explored the experiences of children whilst only one study explored the experiences of parents during the ambulance encounter [ 13 ].…”

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

“…Although there are barriers significantly limiting the measures used by ETs to reduce pain (lack of skills to obtain venous access, difficult pain assessment in preverbal children and toddlers, low experience of ETs in treating children, medical interventions at night, short transport time to hospital), the barriers should not justify untreated acute pain in children [ 4 , 5 , 6 ].…”