Whiston Caroline, Ali Samina, Wright Bruce, Wonnacott David, Stang Antonia S, Thompson Graham C, Bhat Chirag, Todorovich Sydney, Mishra Ashutosh, Laczko Dora, Miller Michael, Poonai Naveen
*Department of Pediatrics,Schulich School of Medicine & Dentistry,Western University,London,ON.
†Department of Pediatrics,University of Alberta,Edmonton,AB.
CJEM. 2018 Nov;20(6):892-902. doi: 10.1017/cem.2018.11. Epub 2018 Feb 26.
The suboptimal provision of analgesia to children in the emergency department (ED) is well-described. A yet unexplored barrier is caregiver or child refusal of analgesia. We sought to evaluate the frequency of caregiver/child acceptance of analgesia offered in the ED.
We conducted a two-centre cross-sectional study of 743 caregivers of children 4–17 years presenting to the pediatric ED with an acutely painful condition using a survey and medical record review. The primary outcome was the proportion of children/caregiver pairs who accepted analgesia in the ED.
The median (IQR) age of children was 11 (7) years, and 339/743 (45.6%) were female. The overall survey response rate was 73% (743/1018). In the 24 hours preceding ED arrival, the median (IQR) maximal pain score rated by children and caregivers was 8/10 (4) and 5/10 (2), respectively, and 30.4% (226/743) of caregivers offered analgesia. In the ED, children reported a median (IQR) pain score of 8/10 (2) and 54.9% (408/743) were offered analgesia. When offered in the ED, analgesia was accepted by 91% (373/408). Overall, 55.7% (414/743) of children received some form of analgesia.
Most caregivers/children accept analgesia when offered by ED personnel, suggesting refusal is not a major barrier to optimal management of children’s pain and highlighting the importance of ED personnel in encouraging adequate analgesia. A large proportion of children in pain are not offered analgesia by caregivers or ED personnel. Educational strategies for recognizing and treating pain should be directed at children, caregivers, and ED personnel.
急诊科（ED）为儿童提供镇痛治疗的效果欠佳，这一点已有充分描述。一个尚未被探索的障碍是照料者或儿童拒绝接受镇痛治疗。我们试图评估在急诊科提供镇痛治疗时照料者/儿童接受治疗的频率。
我们对743名4至17岁因急性疼痛状况前往儿科急诊科就诊的儿童的照料者进行了一项双中心横断面研究，采用问卷调查和病历回顾的方法。主要结局是在急诊科接受镇痛治疗的儿童/照料者对的比例。
儿童的年龄中位数（四分位间距）为11（7）岁，339/743（45.6%）为女性。总体调查回复率为73%（743/1018）。在到达急诊科之前的24小时内，儿童和照料者评定的最大疼痛评分中位数（四分位间距）分别为8/10（4）和5/10（2），30.4%（226/743）的照料者提供了镇痛治疗。在急诊科，儿童报告的疼痛评分中位数（四分位间距）为8/10（2），54.9%（408/743）的儿童接受了镇痛治疗。在急诊科提供镇痛治疗时，91%（373/408）的儿童接受了治疗。总体而言，55.7%（414/743）的儿童接受了某种形式的镇痛治疗。
大多数照料者/儿童在急诊科工作人员提供镇痛治疗时会接受，这表明拒绝并非儿童疼痛最佳管理的主要障碍，并突出了急诊科工作人员在鼓励充分镇痛方面的重要性。很大一部分疼痛儿童未得到照料者或急诊科工作人员提供的镇痛治疗。针对识别和治疗疼痛的教育策略应面向儿童、照料者和急诊科工作人员。
