Aguilar de la Red Yurena, Manrique Martín Gema, Guerrero Marquez Gloria, González Herrero Concepción, Vázquez López Paula, Míguez Navarro Concepción
Hospital General Universitario Gregorio Marañón, Servicio de Pediatría, Madrid, España.
Arch Argent Pediatr. 2018 Feb 1;116(1):28-34. doi: 10.5546/aap.2018.eng.28.
An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge.
Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered.
In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p < 0.01). At home, no analgesia was administered to 39.3%; scheduled analgesia, to 36.1%; and as needed, to 23%. There is little correlation between prescription at discharge and at home (Kappa: 0.178). Analgesia was considered adequate in 84% of cases, and was more frequent in trauma injuries than in infections (85.7% versus 14.3%, p < 0.01).
Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections.
在急诊科，疼痛管理不足的情况很常见。我们的目的是分析急诊科中患有口腔面部感染或创伤的儿童的疼痛管理情况，并评估出院时所开镇痛药的依从性和满意度。
对在两个月内因口腔面部感染或创伤到急诊科就诊的儿童进行横断面、观察性和分析性研究。记录急诊科的疼痛管理情况、在家中所开的镇痛药，以及在给家长打电话后所提供的治疗及其控制疼痛的充分性。
共纳入252例患者（平均年龄：4.5岁，标准差：3.89）。分诊时记录了8.7%的疼痛评估情况，在病历中记录的为3.6%。急诊室中41.3%的患者接受了镇痛治疗。出院时，13.9%的患者未开镇痛药；25.4%的患者开了定时镇痛药；60.3%的患者开了按需镇痛药。儿科医生比外科医生更频繁地开定时镇痛药（34.4%对16.5%，p<0.01）。在家中，39.3%的患者未服用镇痛药；36.1%的患者服用了定时镇痛药；23%的患者服用了按需镇痛药。出院时和在家中的处方之间相关性很小（Kappa值：0.178）。84%的病例中镇痛被认为是充分的，创伤性损伤中比感染性损伤更频繁（85.7%对14.3%，p<0.01）。
急诊科的疼痛评估和管理很少。最常见的处方是按需用药，这与指南中的建议相反。镇痛控制对创伤性损伤比对感染性损伤效果更好。
