Chu H, Brailey R, Clarke E, Sen S K
Department of Burns, Plastic and Reconstructive Surgery, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol BS2 8BJ, United Kingdom.
Department of Burns, Plastic and Reconstructive Surgery, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol BS2 8BJ, United Kingdom.
Burns. 2021 Nov;47(7):1635-1638. doi: 10.1016/j.burns.2021.01.012. Epub 2021 Feb 10.
The majority of patients who sustained small (low % total body surface area [TBSA]) burns are assessed in an outpatient setting. This can be a traumatic experience, particularly, for paediatric patients. During the initial assessment pharmacological and non-pharmacological adjuncts, such as distraction therapy, can be employed to provide an environment that may reduce and minimise distress. In this study, we investigated whether distraction therapy reduces objective pain scores during the outpatient assessment of small acute burns in children.
Two cohorts of patients were formed. In the first group (group A), the children received analgesia and routine nursing care. In the second group (group B), the children received specialist distraction therapy in addition to the same analgesia and nursing care. We recorded patient demographics, TBSA, anatomical sites and mechanism of burn. The Wong Baker™ visual analogue scale (VAS) was used to convert perceived pain, as reported by the patient or parent, into a numerical value at three set intervals during the consultation.
50 patients were recruited with 32 patients in group A and 18 in group B. A larger TBSA positively correlated with higher pain scores (p < 0.05). At the start of the consultation the mean pain score without distraction therapy was 1.55 and with specialist distraction therapy was 0.33 (p < 0.05). The mean peak pain score during dressing change without distraction therapy was 6.80 and with specialist distraction was 4.47 (p < 0.05). At the end of the procedure, the mean pain score was 2.12 without distraction therapy and with specialist distraction 1.75.
This study of pain scores in small acute paediatric burns has shown that distraction therapy provided by a qualified play specialist can reduce maximal pain by over 2 points on the Wong-Baker™ VAS. Consideration should be given to ensure that distraction therapy is available at all times during initial consultations for children who have sustained small burns.
大多数小面积（低总体表面积[TBSA]）烧伤患者在门诊环境中接受评估。这可能是一次创伤性经历，尤其是对儿科患者而言。在初始评估期间，可以采用药物和非药物辅助手段，如分散注意力疗法，以营造一个可能减轻并将痛苦降至最低的环境。在本研究中，我们调查了分散注意力疗法在儿童小面积急性烧伤门诊评估期间是否能降低客观疼痛评分。
形成了两组患者。在第一组（A组）中，儿童接受镇痛和常规护理。在第二组（B组）中，儿童除接受相同的镇痛和护理外，还接受专业的分散注意力疗法。我们记录了患者的人口统计学数据、TBSA、烧伤的解剖部位和机制。在会诊期间的三个设定时间间隔，使用面部表情疼痛评分量表（Wong Baker™视觉模拟量表[VAS]）将患者或家长报告的感知疼痛转换为数值。
招募了50名患者，A组32名，B组18名。较大的TBSA与较高的疼痛评分呈正相关（p < 0.05）。在会诊开始时，无分散注意力疗法时的平均疼痛评分为1.55，有专业分散注意力疗法时为0.33（p < 0.05）。在换药期间，无分散注意力疗法时的平均峰值疼痛评分为6.80，有专业分散注意力疗法时为4.47（p < 0.05）。在操作结束时，无分散注意力疗法时的平均疼痛评分为2.12，有专业分散注意力疗法时为1.75。
这项关于儿童小面积急性烧伤疼痛评分的研究表明，由合格的游戏专家提供的分散注意力疗法可使面部表情疼痛评分量表（Wong-Baker™VAS）上的最大疼痛降低超过2分。应考虑确保在小面积烧伤儿童的初始会诊期间随时提供分散注意力疗法。
