van der Heijden Marianne J E, de Jong Alette, Rode Heinz, Martinez Roux, van Dijk Monique
Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands.
Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Association of Dutch Burn Centers, Beverwijk, The Netherlands; Department of Rehabilitation, Nursing Science and Sports, University Medical Center, Utrecht, The Netherlands.
Burns. 2018 Feb;44(1):175-182. doi: 10.1016/j.burns.2017.07.004. Epub 2017 Aug 8.
While the prevalence of burns in children is highest in low and middle-income countries, most research on burn-related pain intensity and distress is carried out in high-income countries. In this study we assessed pain intensity and distress in paediatric patients with burns undergoing wound care procedures without distraction and parental presence in a South-African children's hospital and sought to identify predictors for the outcomes.
This observational study, carried out as part of a randomized controlled trial, took place at a burns unit in Cape Town, South Africa and included patients between the ages of 0 and 13 years undergoing their first or second wound care procedure. We measured pain intensity and distress using the COMFORT Behavioural scale (COMFORT-B) across four distinct phases of wound care procedures: removal of bandage; washing the wound; administering wound care; putting on new dressings. COMFORT-B scores ≥21 indicate severe pain intensity and distress.
124 patients were included, median age 21.2 months (IQR 14.9-39.5 months), 90% suffered scalds, and median total body surface 8% (IQR 5-14%). Assessment scores for the majority of patients were indicative of severe pain intensity and distress during wound care procedures. Median COMFORT-B scores across the four phases were 24, 25, 25 and 22 respectively. Across the four phases respectively 76%; 89%; 81% and 62% of the patients were indicated with severe pain intensity and distress. Age was a predictor for pain intensity and distress as younger children were assigned higher scores than older children (Unstandardized B -.052; 95% CI -.071 to -.032 p<0.001).
In this study children received wound care procedures without distraction or parental presence and were assessed to have high pain intensity and distress. There is a correlation between age and COMFORT-B scores: younger children show higher distress, indicating a great need for better pain and distress control during wound care procedures. It is difficult to identify whether pain or distress is the specific primary cause for the high COMFORT-B scores.
虽然儿童烧伤的患病率在低收入和中等收入国家最高，但大多数关于烧伤相关疼痛强度和痛苦程度的研究是在高收入国家进行的。在本研究中，我们评估了南非一家儿童医院中接受伤口护理程序且无分心因素和父母陪伴的烧伤儿科患者的疼痛强度和痛苦程度，并试图确定这些结果的预测因素。
本观察性研究作为一项随机对照试验的一部分，在南非开普敦的一个烧伤科进行，纳入了年龄在0至13岁之间接受首次或第二次伤口护理程序的患者。我们在伤口护理程序的四个不同阶段使用舒适行为量表（COMFORT-B）测量疼痛强度和痛苦程度：去除绷带；清洗伤口；进行伤口护理；更换新敷料。COMFORT-B评分≥21表明疼痛强度和痛苦程度严重。
纳入124例患者，中位年龄21.2个月（四分位间距14.9 - 39.5个月），90%为烫伤，中位体表面积8%（四分位间距5 - 14%）。大多数患者在伤口护理程序中的评估得分表明疼痛强度和痛苦程度严重。四个阶段的COMFORT-B中位评分分别为24、25、25和22。在四个阶段中，分别有76%、89%、81%和62%的患者被评定为疼痛强度和痛苦程度严重。年龄是疼痛强度和痛苦程度的一个预测因素，因为年幼儿童的得分高于年长儿童（非标准化B值为-.052；95%置信区间为-.071至-.032，p<0.001）。
在本研究中，儿童在无分心因素或父母陪伴的情况下接受伤口护理程序，且被评定为疼痛强度和痛苦程度较高。年龄与COMFORT-B评分之间存在相关性：年幼儿童表现出更高的痛苦程度，这表明在伤口护理程序中非常需要更好地控制疼痛和痛苦。很难确定疼痛还是痛苦是COMFORT-B高分的具体主要原因。
