University of Toronto, Toronto, Canada.
University of British Columbia, Kelowna, Canada.
PLoS One. 2023 Dec 21;18(12):e0296240. doi: 10.1371/journal.pone.0296240. eCollection 2023.
Pediatric patients with pain of various causes present to the emergency department. Appropriate assessment and management of pain are important aspects of emergency department treatment. However, only a few studies have identified the predictors of both outcomes. This study aimed to evaluate the rate of pain assessment at triage and subsequent management and to identify the predictors of each outcome.
This was a multi-center retrospective study based at five community emergency departments. Pediatric patients (< 18 years) with pain or injury who presented to the emergency department between February 2018 and May 2018 were included. In addition to patient demographics, the initial pain assessment at triage, reason for visit, and time to analgesia were determined. Further, the type and route of analgesia were identified in patients who received analgesia. Univariate and multivariable regression models were used to identify predictors of pain assessment and management.
There were 4,128 patients with an average age of 9.6 years, and 49.1% of them were female. Only 74.2% of the patients underwent assessment for pain at triage, and 18.3% received analgesia. The median time to analgesia was 95 (IQR: 49-154) min. Most patients presented with head/neck (36.1%), upper limb (21.6%), and lower limb (19.9%) pain. The oral route was the most common analgesia delivery method (67.4%), and ibuprofen and acetaminophen were the primary agents used. Younger age, higher acuity, and presenting with head or neck pain were independent predictors of pain assessment at triage, while children 3-5 years and those with lower extremity pain were more likely to receive analgesia.
Although pain assessment at triage has improved in pediatric patients, there is still a major deficiency in adequate pain management. Our study highlights predictors of pain assessment and management that can be considered for improved pediatric care.
患有各种原因疼痛的儿科患者会到急诊科就诊。对疼痛进行适当的评估和管理是急诊科治疗的重要方面。但是，只有少数研究确定了这两个结果的预测因素。本研究旨在评估分诊时疼痛评估的发生率以及随后的管理，并确定每个结果的预测因素。
这是一项基于五个社区急诊科的多中心回顾性研究。纳入 2018 年 2 月至 2018 年 5 月期间因疼痛或损伤到急诊科就诊的<18 岁的儿科患者。除了患者的人口统计学特征外，还确定了分诊时的初始疼痛评估、就诊原因和镇痛时间。此外，在接受镇痛的患者中确定了镇痛的类型和途径。使用单变量和多变量回归模型来确定疼痛评估和管理的预测因素。
共有 4128 名患者，平均年龄为 9.6 岁，其中 49.1%为女性。只有 74.2%的患者在分诊时接受了疼痛评估，18.3%的患者接受了镇痛。镇痛的中位数时间为 95（IQR：49-154）分钟。大多数患者表现为头部/颈部（36.1%）、上肢（21.6%）和下肢（19.9%）疼痛。口腔途径是最常见的镇痛给药方法（67.4%），布洛芬和对乙酰氨基酚是主要使用的药物。年龄较小、病情较严重以及表现为头部或颈部疼痛是分诊时进行疼痛评估的独立预测因素，而 3-5 岁的儿童和下肢疼痛的儿童更有可能接受镇痛。
尽管儿科患者的分诊时疼痛评估有所改善，但在充分的疼痛管理方面仍存在重大缺陷。我们的研究强调了疼痛评估和管理的预测因素，可考虑改善儿科护理。
