From the Departments of Emergency Medicine.
Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN.
Pediatr Emerg Care. 2023 Mar 1;39(3):135-141. doi: 10.1097/PEC.0000000000002744. Epub 2022 May 17.
Our objectives were to quantify pain experienced by young children undergoing facial laceration repair and identify factors associated with low procedural pain scores.
We conducted a prospective cohort study of children's distress among a convenience sample of children aged 1 to 5 years undergoing facial or scalp laceration repair in 2 pediatric emergency departments. We reviewed video recordings and documented pain scores at 15-second intervals using the Face, Leg, Activity, Cry, Consolability-Revised (FLACC-r) scale. We dichotomized FLACC-r into low/high scores (≤3 and >3) to evaluate practice variables.
We included 11,474 FLACC-r observations from 258 procedures in the analysis. Two-thirds of 3- to 5-year-olds completed their laceration repair without the use of restraint, sedation, or anxiolytics. Mean distress scores were low (≤2.5 out of 10) across all procedure phases for 2- to 5-year-old patients. One-year-old patients experienced significantly more distress than their older counterparts (mean ≤4.2 out of 10). Odds of having low FLACC scores (≤3) were greater for patients with an expert clinician (adjusted odds ratio [aOR]: 1.72; 95% confidence interval [CI], 1.05-2.84). Wound infiltration (aOR, 0.35; 95% CI, 0.13-0.93), patient observation of a needle (aOR, 0.21; 95% CI, 0.14-0.33), and restraint (aOR, 0.04; 95% CI, 0.02-0.06) were negatively associated with low FLACC score.
The majority of 3- to 5-year-old patients were able to undergo facial laceration repair without restraint, sedation, or anxiolytics and with low mean distress scores. Our findings suggest that children's risk of experiencing moderate and severe distress during facial and scalp laceration repair may be reduced by prioritizing wound closure by expert-level clinicians, ensuring effective lidocaine-epinephrine-tetracaine application, avoiding restraint, and concealing needles from patient view.
本研究旨在量化接受面部裂伤修复术的幼儿所经历的疼痛程度，并确定与低操作疼痛评分相关的因素。
我们对两家儿科急诊部门的便利样本中年龄在 1 至 5 岁之间接受面部或头皮裂伤修复的儿童进行了一项前瞻性队列研究。我们对视频记录进行了回顾，并使用面部、腿部、活动、哭泣、安抚性修订版（FLACC-r）量表以 15 秒为间隔记录疼痛评分。我们将 FLACC-r 分为低/高评分（≤3 和>3），以评估实践变量。
我们对 258 例手术中的 11474 个 FLACC-r 观察结果进行了分析。三分之二的 3 至 5 岁儿童在没有约束、镇静或焦虑药物的情况下完成了裂伤修复。对于 2 至 5 岁的患者，所有手术阶段的痛苦评分均较低（≤10 分中的 2.5 分）。与年龄较大的患者相比，1 岁的患者经历了更多的痛苦（平均≤10 分中的 4.2 分）。对于有专家医生的患者，低 FLACC 评分（≤3）的可能性更大（调整后的优势比[aOR]：1.72；95%置信区间[CI]，1.05-2.84）。伤口浸润（aOR：0.35；95%CI：0.13-0.93）、患者观察到针头（aOR：0.21；95%CI：0.14-0.33）和约束（aOR：0.04；95%CI：0.02-0.06）与低 FLACC 评分呈负相关。
大多数 3 至 5 岁的儿童无需约束、镇静或焦虑药物即可接受面部裂伤修复术，且疼痛评分均值较低。我们的研究结果表明，通过优先由专家级医生进行伤口闭合、确保有效实施利多卡因-肾上腺素-四卡因、避免约束以及避免让患者看到针头，可以降低儿童在面部和头皮裂伤修复过程中经历中度和重度疼痛的风险。
