Paediatric Emergency Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
BMJ Paediatr Open. 2022 Mar;6(1). doi: 10.1136/bmjpo-2021-001273.
Management of acute pain should commence at the earliest opportunity, as it has many short-term and long-term consequences. A research priority of Paediatric Emergency Research in the UK and Ireland (PERUKI) was to examine paediatric pain practices.
To describe the outcomes for paediatric pain management of minor injuries presenting to emergency departments (EDs) across PERUKI.
A retrospective service evaluation was performed over a 7-day period in late 2016/early 2017 across PERUKI sites, and analysis performed using an adapted Donabedian framework. Patients under 16 years presenting with minor trauma were eligible, and data were collected on prehospital management, pain assessment, analgesia administered and injury diagnosed.
Thirty-one sites submitted data on 3888 patients. There were 111 missed cases (missed rate 3.6%). The most common injuries were sprains, lacerations, contusions/abrasions and fractures. Documentation of receiving analgesia before arrival in ED occurred in 21% of patients (n=818). A pain assessment was documented in 57.5% of patients (n=2235) during their ED visit, and 3.5% of patients had their pain reassessed (n=138). Of the patients who presented in severe pain (pain score 7-10 or rated severe), 11% were reassessed. Site variability of initial pain assessment ranged from 1.4% to 100% (median 62%). The characteristics of the top quartile performing centres against the bottom quartile performing centres based on completion rate of initial pain scores were identified.
Pain assessment was documented in under 60% of children with minor injury, re-assessment of pain was almost completely absent, data and outcomes were missing in a substantial volume of patients, indicating that pain management and the associated outcomes have not been adequately addressed and prioritised within existing network structures and processes.
急性疼痛的管理应尽早开始，因为它有许多短期和长期的后果。英国和爱尔兰儿科急诊研究（PERUKI）的一个研究重点是检查儿科疼痛治疗。
描述在 PERUKI 各站点，因轻伤到急诊部就诊的儿科疼痛管理的结果。
在 2016 年末至 2017 年初，在 PERUKI 站点进行了为期 7 天的回顾性服务评估，分析采用了经改编的 Donabedian 框架。16 岁以下因轻伤就诊的患者符合条件，收集了院前管理、疼痛评估、给予的镇痛剂和诊断的损伤数据。
31 个站点提供了 3888 例患者的数据。有 111 例漏诊（漏诊率 3.6%）。最常见的损伤是扭伤、撕裂伤、挫伤/擦伤和骨折。在抵达急诊部前接受镇痛剂的患者中，21%（n=818）记录在案。在急诊部就诊期间，57.5%（n=2235）的患者记录了疼痛评估，3.5%（n=138）的患者重新评估了疼痛。在疼痛评分为 7-10 或评为严重的患者中，有 11%重新评估。初始疼痛评估的站点变异性范围为 1.4%至 100%（中位数为 62%）。根据初始疼痛评分完成率，确定了表现最好的前四分之一和表现最差的四分之一中心的特征。
仅有不到 60%的轻伤儿童记录了疼痛评估，疼痛重新评估几乎完全缺失，大量患者的数据和结果缺失，这表明疼痛管理和相关结果在现有网络结构和流程中尚未得到充分解决和优先考虑。
