Zontag Dafna, Honigman Liat, Kuperman Pora, Treister Roi
Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
Department of Pediatric Surgery, Rambam Health Care Campus, Haifa, Israel.
Front Pediatr. 2021 Jul 9;9:672324. doi: 10.3389/fped.2021.672324. eCollection 2021.
Accurate assessment of patients' pain is an essential part of adequate analgesic treatment. Although reporting pain is a complex task, limited-to-no instructions are provided to pediatric patients regarding this process. Our goal in this randomized parallel-group clinical trial (Clinicaltrial.gov study protocol number NCT04306679) was to evaluate if a training program designed to improve children's ability to understand and use pain scales in a post-surgical setting would affect their pain scores. Eligible children (aged 8-17), hospitalized for elective surgery and their parents were randomized into two groups. Pre-surgery the intervention group underwent a multi-media program aimed to teach and train how to report pain. The control group received standard pre-surgical instructions. Post-surgery, the children reported their pain on 4 pain scales. The primary outcome was the concordance between children's pain intensity scores reported on four pain scales, both in terms of within-child standard deviation and absolute difference. Ninety-six children met inclusion criteria and completed the study. The trained subjects' pain reports had significantly ( = 0.002) lower within-subject standard deviation (0.41 ± 0.31) than the control group (0.67 ± 0.46). In line, regarding absolute difference, the concordance of children's pain reports was twice better in the trained group (mean difference of 0.43 ± 0.40) than in the control group (0.88 ± 0.70) ( < 0.001). Our results suggests that children's ability to report pain is a skill that can be improved. Future studies should test the potential clinical impacts of educational interventions aimed to improve pain assessment in children and adults.
准确评估患者的疼痛是充分镇痛治疗的重要组成部分。尽管报告疼痛是一项复杂的任务,但针对儿科患者在这个过程中提供的指导却非常有限甚至没有。我们在这项随机平行组临床试验(Clinicaltrial.gov研究方案编号NCT04306679)中的目标是评估一个旨在提高儿童在术后环境中理解和使用疼痛量表能力的培训项目是否会影响他们的疼痛评分。符合条件的儿童(8 - 17岁)因择期手术住院,他们及其父母被随机分为两组。术前,干预组接受了一个旨在教授和培训如何报告疼痛的多媒体项目。对照组接受标准的术前指导。术后,孩子们在4种疼痛量表上报告他们的疼痛情况。主要结局是儿童在4种疼痛量表上报告的疼痛强度评分之间的一致性,包括儿童内部标准差和绝对差异。96名儿童符合纳入标准并完成了研究。接受培训的受试者的疼痛报告在受试者内部标准差方面(= 0.002)显著低于对照组(0.67 ± 0.46),为0.41 ± 0.31。同样,就绝对差异而言,接受培训组儿童疼痛报告的一致性(平均差异为0.43 ± 0.40)是对照组(0.88 ± 0.70)的两倍(< 0.001)。我们的结果表明,儿童报告疼痛的能力是一项可以提高的技能。未来的研究应该测试旨在改善儿童和成人疼痛评估的教育干预措施的潜在临床影响。