Nicholls Georgie, Eaton Georgette, Ortega Marishona, Sumera Kacper, Baliousis Michael, Hodgson Jessica, Laparidou Despina, Siriwardena Aloysius Niroshan, Leighton Paul, Redsell Sarah, Lord Bill, Bujor Tatiana, Whitley Gregory Adam
Community and Health Research Unit, University of Lincoln, Lincoln, England, LN6 7FS, UK.
London Ambulance Service NHS Trust, London, England, SE1 8SD, UK.
NIHR Open Res. 2025 Jan 30;4:42. doi: 10.3310/nihropenres.13627.2. eCollection 2024.
Each year in England, 450,000 children and young people (CYP) under 18 years of age are transported by ambulance to emergency departments. Approximately 20% of these suffer acute pain caused by illness or injury. Pain is a highly complex sensory and emotional experience. The intersection between acute pain, unwell CYP and the unpredictable pre-hospital environment is convoluted. Studies have shown that prehospital pain management in CYP is poor, with 61% of those suffering acute pain not achieving effective pain relief (abolition or reduction of pain score by 2 or more out of 10) when attended by ambulance. Consequences of poor acute pain management include altered pain perception, post-traumatic stress disorder and the development of chronic pain. This realist review will aim to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP.
A realist review will be conducted in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. A five-stage approach will be adopted; 1) Developing an Initial Programme Theory (IPT): develop an IPT with key stakeholder input and evidence from informal searching; 2) Searching and screening: conduct a thorough search of relevant research databases and other literature sources and perform screening in duplicate; 3) Relevance and rigour assessment: assess documents for relevance and rigour in duplicate; 4) Extracting and organising data: code relevant data into conceptual "buckets" using qualitative data analysis software; and 5) Synthesis and Programme Theory (PT) refinement: utilise a realist logic of analysis to generate context-mechanism-outcome configurations (CMOCs) within and across conceptual "buckets", test and refine the IPT into a realist PT.
The realist PT will enhance our understanding of what works best to improve acute prehospital pain management in CYP, which will then be tested and refined within a realist evaluation.
PROSPERO Registration: CRD42024505978.
在英格兰，每年有45万名18岁以下的儿童和青少年（CYP）被救护车送往急诊科。其中约20%的人因疾病或受伤而遭受急性疼痛。疼痛是一种高度复杂的感官和情感体验。急性疼痛、身体不适的CYP与不可预测的院前环境之间的交叉情况错综复杂。研究表明，CYP的院前疼痛管理较差，在由救护车接诊时，61%遭受急性疼痛的人未能实现有效的疼痛缓解（疼痛评分降低2分或更多，满分10分）。急性疼痛管理不善的后果包括疼痛感知改变、创伤后应激障碍以及慢性疼痛的发展。本实证性综述旨在了解救护车临床医生如何为CYP提供更好的院前急性疼痛管理。
将根据实证性和元叙事证据综合：不断发展的标准（RAMESES）指南进行实证性综述。将采用五阶段方法；1）制定初始项目理论（IPT）：在关键利益相关者的参与下，根据非正式检索的证据制定IPT；2）检索和筛选：对相关研究数据库和其他文献来源进行全面检索，并进行双人筛选；3）相关性和严谨性评估：对文件进行双人相关性和严谨性评估；4）提取和整理数据：使用定性数据分析软件将相关数据编码到概念性“桶”中；5）综合和项目理论（PT）完善：利用实证性分析逻辑在概念性“桶”内和跨概念性“桶”生成背景-机制-结果配置（CMOC），将IPT测试并完善为实证性PT。
实证性PT将增强我们对改善CYP院前急性疼痛管理的最佳方法的理解，然后在实证性评估中对其进行测试和完善。
PROSPERO注册：CRD42024505978。
