University of Trieste, Trieste, Italy.
Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
BMJ Paediatr Open. 2024 Aug 30;8(Suppl 7):e002610. doi: 10.1136/bmjpo-2024-002610.
There is little experience on the use of the WHO Standards for improving the quality of care (QOC) for children. We describe the use of four prioritised WHO Standard-based Quality Measures to assess the provision of care for children with pain in emergency departments (EDs).
In a multicentre observational study in 10 EDs with different characteristics in Italy, we collected data on 3355 children accessing the EDs between January 2019 and December 2020. The association between children and facility characteristics and quality measures was analysed through multivariate analyses.
The proportion of children whose pain was measured was 68.7% (n=2305), with extreme variations across different centres (from 0.0% to 99.8%, p<0.001). The proportion of children treated for pain was 28.9% (n=970) again with a wide range (5.3%-56.3%, p<0.001). The difference between the frequency of children with pain measured and pain treated varied widely between the facilities (ranging from -24.3 to 82). Children with moderate and severe pain were more frequently treated (48.9% and 62.9% of cases, respectively), although with large variations across centres (ranges: 0%-74.8% and 0%-100% respectively, p<0.001). After correction for children's characteristics, the variable more strongly associated with analysed outcomes was the facility which the child accessed for care. Being a facility in Northern Italy was associated with a higher rate of pain measurement (67.3%-95% CI: 39.9% to 94.6%, p<0.001) compared with facilities in South Italy (-22.1% lower (95% CI: -41.7% to -2.50%, p=0.03).
The use of few WHO Standard-based measures related to pain can help identifying priority gaps in QOC for children and in monitoring it over time. There is a need for more implementation research to establish which are the most sustainable and effective interventions to improve the QOC for acute pain in children.
在提高儿童保健质量（QOC）方面，世卫组织标准的使用经验很少。我们描述了使用四项基于世卫组织标准的优先质量措施来评估急诊科（ED）中疼痛儿童的护理提供情况。
在意大利 10 家具有不同特征的急诊科进行的一项多中心观察性研究中，我们收集了 2019 年 1 月至 2020 年 12 月期间进入急诊科的 3355 名儿童的数据。通过多变量分析分析了儿童和设施特征与质量措施之间的关系。
有疼痛的儿童中，有 68.7%（n=2305）的疼痛得到了测量，不同中心之间存在很大差异（从 0.0%到 99.8%，p<0.001）。同样，有 28.9%（n=970）的儿童接受了疼痛治疗，范围也很广（5.3%-56.3%，p<0.001）。测量疼痛的儿童和接受疼痛治疗的儿童之间的差异在设施之间差异很大（范围为-24.3 到 82）。有中度和重度疼痛的儿童更常接受治疗（分别为 48.9%和 62.9%的病例），尽管各中心之间存在较大差异（范围分别为 0%-74.8%和 0%-100%，p<0.001）。在对儿童特征进行校正后，与分析结果相关性最强的变量是儿童接受护理的设施。与意大利南部的设施相比，意大利北部的设施接受疼痛测量的比例更高（67.3%-95%CI：39.9%至 94.6%，p<0.001）（低 22.1%（95%CI：-41.7%至-2.50%，p=0.03）。
使用少数与疼痛相关的基于世卫组织标准的措施可以帮助确定儿童 QOC 的优先差距，并对其进行持续监测。需要更多的实施研究来确定哪些是改善急性疼痛儿童 QOC 最可持续和有效的干预措施。
