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Olutoye OO, Eriksson E, Menchaca AD, Kirsner RS, Tanaka R, Schultz G, Weir D, Wagner TL, Fabia RB, Naik-Mathuria B, Liu PY, Ead JK, Adebayo T, Armstrong DG, McMullin N, Samora JB, Akingba AG. Management of Acute Wounds-Expert Panel Consensus Statement. Adv Wound Care (New Rochelle) 2024. [PMID: 38618741 DOI: 10.1089/wound.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Significance: The Wound Healing Foundation recognized the need for consensus-based unbiased recommendations for the treatment of wounds. As a first step, a consensus on the treatment of chronic wounds was developed and published in 2022. The current publication on acute wounds represents the second step in this process. Acute wounds may result from any number of conditions, including burns, military and combat operations, and trauma to specific areas of the body. The management of acute wounds requires timely and evidence-driven intervention to achieve optimal clinical outcomes. This consensus statement provides the clinician with the necessary foundational approaches to the causes, diagnosis, and therapeutic management of acute wounds. Presented in a structured format, this is a useful guide for clinicians and learners in all patient care settings. Recent Advances: Recent advances in the management of acute wounds have centered on stabilization and treatment in the military and combat environment. Specifically, advancements in hemostasis, resuscitation, and the mitigation of infection risk through timely initiation of antibiotics and avoidance of high-pressure irrigation in contaminated soft tissue injury. Critical Issues: Critical issues include infection control, pain management, and the unique considerations for the management of acute wounds in pediatric patients. Future Directions: Future directions include new approaches to preventing the progression and conversion of burns through the use of specific gel formulations. Additionally, the use of three-dimensional bioprinting and photo-modulation for reconstruction is a promising area for continued discovery.
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Affiliation(s)
- Oluyinka O Olutoye
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Elof Eriksson
- Harvard Medical School, Cambridge, Massachusetts, USA
| | - Alicia D Menchaca
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert S Kirsner
- University of Miami Hospital and Clinics Wound Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rica Tanaka
- Juntendo University Graduate School of Medicine, Division of Regenerative Therapy, Department of Plastic & Reconstructive Surgery, Juntendo University Hospital Podiatry Center, Tokyo, Japan
| | - Greg Schultz
- University of Florida, Gainesville, Florida, USA
| | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, New York, USA
| | - Tracey L Wagner
- Department of Pediatrics, Section of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Renata B Fabia
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Paul Y Liu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - J Karim Ead
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Temitope Adebayo
- Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania, USA
| | - David G Armstrong
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Neil McMullin
- Plastic Surgery Consultant to the Surgeon General of the Army, Evans Army Community Hospital, Fort Carson, Colorado, USA
| | - Julie Balch Samora
- Department of Orthopedics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - A George Akingba
- Department of Vascular Surgery, VA Medical Center, Washington, District of Columbia, USA
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Schnuck JK, Javid PJ, Riehle KJ, Rothstein DH. Chest Tube Management Following Lung Resection In Pediatric Patients: A Retrospective Analysis. J Pediatr Surg 2023:S0022-3468(23)00171-9. [PMID: 37003926 DOI: 10.1016/j.jpedsurg.2023.02.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Pleural drainage following lung resection is almost universally practiced in pediatric surgery, but its necessity has been questioned in adult literature. We performed a cross-sectional study of pediatric patients undergoing lung resection to characterize chest tube (CT) practices and clarify their utility. METHOD Retrospective chart review of patients <21 years of age undergoing pulmonary lobectomy or wedge resection at an academic children's hospital from 2013 to 2022. Variables regarding demographics and post-operative CT management were recorded. RESULTS 130 procedures meet inclusion criteria: 59 lobectomies (group 1), 19 diagnostic wedges (group 2), and 52 excisional wedges (group 3). 74.6% of group 1 patients had no air leak, and median CT duration was 2 days. In group 2, 89.5% had no air leak and median CT duration was 1 day. In Group 3, 80.8% had no air leak and median CT duration was 1 day. Overall, 43.1% patients had their CT removed on post-operative day 1 and 21.5% on post-operative day 2. CONCLUSION CT duration following lung resection in pediatric patients is typically brief, with most patients having no air leak and CT removal within 2 days of surgery. Obligatory CT drainage may not be necessary in select patients undergoing lung resection. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Retrospective Study.
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Affiliation(s)
- Jamie K Schnuck
- Department of General Surgery, University of Washington, Seattle, WA, USA.
| | - Patrick J Javid
- Department of General Surgery, University of Washington, Seattle, WA, USA; Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Kimberly J Riehle
- Department of General Surgery, University of Washington, Seattle, WA, USA; Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - David H Rothstein
- Department of General Surgery, University of Washington, Seattle, WA, USA; Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA
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Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy Diagnostic Criteria for Acute Needle Pain. THE JOURNAL OF PAIN 2023; 24:387-402. [PMID: 36243317 DOI: 10.1016/j.jpain.2022.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
Needle procedures are among the most common causes of pain and distress for individuals seeking health care. While needle pain is especially problematic for children needle pain and associated fear also has significant impact on adults and can lead to avoidance of appropriate medical care. Currently there is not a standard definition of needle pain. A taxonomy, or classification system, for acute needle pain would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including needle pain. To accomplish this, a working group of experts in needle pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact and/or functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific needle pain. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of needle associated fear, are proposed to define the types of acute needle pain. PERSPECTIVE: This article presents a taxonomy for acute needle pain. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients undergoing needle procedures.
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Harris MI, Adelgais KM, Linakis SW, Magill CF, Brazauskas R, Shah MI, Nishijima DK, Lowe GS, Chadha K, Chang TP, Lerner EB, Leonard JC, Schwartz HP, Gaither JB, Studnek JR, Browne LR. Impact of Prehospital Pain Management on Emergency Department Management of Injured Children. PREHOSP EMERG CARE 2023; 27:1-9. [PMID: 34734787 DOI: 10.1080/10903127.2021.2000683] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Provision of analgesia for injured children is challenging for Emergency Medical Services (EMS) clinicians. Little is known about the effect of prehospital analgesia on emergency department (ED) care. We aimed to determine the impact of prehospital pain interventions on initial ED pain scale scores, timing and dosing of ED analgesia for injured patients transported by EMS. METHODS This is a planned, secondary analysis of a prospective multicenter cohort of children with actual or suspected injuries transported to one of 11 PECARN-affiliated EDs from July 2019-April 2020. Using Wilcoxon rank sum for continuous variables and chi-square testing for categorical variables, we compared the change in EMS-to-ED pain scores and timing and dosing of ED-administered opioid analgesia in those who did and those who did not receive prehospital pain interventions. RESULTS We enrolled 474 children with complete prehospital and ED pain management data. Prehospital interventions were performed on 262/474 (55%) of injured children and a total of 88 patients (19%) received prehospital opioids. Children who received prehospital opioids with or without adjunctive non-pharmacologic pain management experienced a greater reduction in pain severity and were more likely to receive ED opioids in higher doses earlier and throughout their ED care. Non-pharmacologic pain interventions alone did not impact ED care. CONCLUSIONS We demonstrate that prehospital opioid analgesia is associated with both a significant reduction in pain severity at ED arrival and the administration of higher doses of opioid analgesia earlier and throughout ED care.
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Affiliation(s)
- M I Harris
- Department of Pediatrics, Northwell Hofstra School of Medicine, New Hyde Park, New York
| | - K M Adelgais
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - S W Linakis
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - C F Magill
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina
| | - R Brazauskas
- Department of Institute for Health Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - M I Shah
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - D K Nishijima
- Department of Emergency Medicine, University of California - Davis, Sacramento, California
| | - G S Lowe
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - K Chadha
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York
| | - T P Chang
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - E B Lerner
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York
| | - J C Leonard
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - H P Schwartz
- Division of Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - J B Gaither
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona
| | - J R Studnek
- Mecklenburg EMS Agency, Charlotte, North Carolina
| | - L R Browne
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Guiner A, Street MH, Oke O, Young VB, Hennes H. Pain Reduction Emergency Protocol: A Prospective Study Evaluating Impact of a Nurse-initiated Protocol on Pain Management and Parental Satisfaction. Pediatr Emerg Care 2022; 38:e157-e164. [PMID: 32701867 DOI: 10.1097/pec.0000000000002193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Pain control remains suboptimal in pediatric emergency departments (EDs). Only 60% of pediatric patients requiring pain medications receive them in the ED, with an average time of administration being 90 minutes after arrival. Although pain protocols (PP) have been proposed and evaluated in children with long-bone fractures, data on PP utility for general pediatric patients with acute pain are limited. Our objective is to introduce a nursing-initiated PP with medication algorithms for use in triage, measure the improvement in management of severe pain on arrival to the ED and determine the effect on parental satisfaction. METHODS Prospective prestudy and poststudy conducted from June to October 2017. Patients aged 3 to 17 years presenting to a large tertiary pediatric ED with acute pain were eligible. Preprotocol demographics, clinical data, and pain interventions were obtained over a 6-week period. A convenience sample of parents completed a satisfaction survey rating their experience with ED pain management during this time. In the 4-week intervention phase, the PP was introduced to our ED nurses. Postintervention data were collected in the same fashion as the preintervention phase. Analysis was done using independent sample t test and χ2 models. RESULTS There were 1590 patients evaluated: preprotocol (n = 816), postprotocol (n = 774). Approximately 10% more patients with severe pain received pain medication in the post-PP sample compared with pre-PP (85.6% and 75.9% respectively). Parental satisfaction was higher in patients who received analgesic medications within 90 minutes of arrival to the ED (P = 0.007). CONCLUSIONS The introduction of a PP in the ED setting improved the treatment of pain. There was a significant increase in patients with severe pain receiving analgesic medications. Additionally, parents were more satisfied if their children received pain medication in a more timely fashion. Pediatric EDs should consider introducing PPs to improve appropriate and timely administration of pain medication in triage.
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Affiliation(s)
| | | | | | - Virginia B Young
- Emergency Services, Children's Health Children's Medical Center Dallas, Dallas, TX
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Rossi S, Santini SJ, Di Genova D, Maggi G, Verrotti A, Farello G, Romualdi R, Alisi A, Tozzi AE, Balsano C. Using social robot NAO for emotional support to children at a paediatric emergency department: a randomised clinical trial. J Med Internet Res 2021; 24:e29656. [PMID: 34854814 PMCID: PMC8796042 DOI: 10.2196/29656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/11/2021] [Accepted: 11/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations. Objective This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels. Methods This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen d-based effect size correlation (r). Results A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (r=0.75). Cortisol levels decreased more in girls (r=0.92) than in boys (r=0.57). Conclusions SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting. Trial Registration ClinicalTrials.gov NCT04627909; https://clinicaltrials.gov/ct2/show/study/NCT04627909
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Affiliation(s)
- Silvia Rossi
- Department of Electrical Engineering and Information Technology, University Federico II-Naples, Naples, IT
| | - Silvano Junior Santini
- Department of life, health & Environmental sciences- MESVA-School of Emergency and Urgency Medicine, University of L'Aquila, via spennati L'aquila 67100, L'Aquila, IT
| | - Daniela Di Genova
- Department of life, health & Environmental sciences- MESVA-School of Emergency and Urgency Medicine, University of L'Aquila, via spennati L'aquila 67100, L'Aquila, IT
| | - Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, IT
| | | | | | - Roberta Romualdi
- Department of life, health & Environmental sciences- MESVA-School of Emergency and Urgency, University of L'Aquila, L'Aquila, IT
| | - Anna Alisi
- Research Unit of Molecular Genetics of Complex Phenotypes, Bambino Gesù Children's Hospital, IRCCS, Rome, IT
| | | | - Clara Balsano
- Department of life, health & Environmental sciences- MESVA-School of Emergency and Urgency Medicine, University of L'Aquila, via spennati L'aquila 67100, L'Aquila, IT
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An observational cohort study comparing ibuprofen and oxycodone in children with fractures. PLoS One 2021; 16:e0257021. [PMID: 34499688 PMCID: PMC8428788 DOI: 10.1371/journal.pone.0257021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/22/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare the effectiveness and safety of prescribing ibuprofen and oxycodone for at-home management of children's fracture pain. METHODS A prospective observational cohort was conducted at the Stollery Children's Hospital pediatric emergency department (June 2010-July 2014). Children aged 4-16 years with an isolated fracture discharged home with advice to use either ibuprofen or oxycodone were recruited. RESULTS A cohort of 329 children (n = 217 ibuprofen, n = 112 oxycodone) were included. Mean age was 11.1 years (SD 3.5); 68% (223/329) were male. Fracture distribution included 80.5% (264/329) upper limb with 34.3% (113/329) requiring fracture reduction. The mean reduction in Faces Pain Score-Revised score (maximum pain-post-treatment pain) for Day 1 was 3.6 (SD 1.9) (ibuprofen) and 3.8 (SD 2.1) (oxycodone) (p = 0.50); Day 2 was 3.6 (SD 1.8) (ibuprofen) and 3.7 (SD 1.6) (oxycodone) (p = 0.56); Day 3 was 3.7 (SD 1.7) (ibuprofen) and 3.3 (SD 1.7) (oxycodone) (p = 0.24). Children prescribed ibuprofen (51.2%, 109/213) experienced less adverse events compared to those prescribed oxycodone (70.5% 79/112) on Day 1 (p = 0.001). Children prescribed ibuprofen (71.8%, 150/209) had their function (eat, play, school, sleep) affected less than those prescribed oxycodone (83.0%, 93/112) (p = 0.03) on Day 1. CONCLUSION Children prescribed ibuprofen or oxycodone experienced similar analgesic effectiveness for at-home fracture pain. Oxycodone prescribing was associated with more adverse events and negatively impacted function. Oxycodone use does not appear to confer any benefit over ibuprofen for pain relief and has a negative adverse effect profile. Ibuprofen appears to be a safe option for fracture-related pain.
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Choi HJ, Kim HJ. Efficacy of Cartoons as a Distraction Technique for Children Undergoing Suture of Facial Lacerations in the Emergency Department. Pediatr Emerg Care 2021; 37:471-473. [PMID: 32195983 DOI: 10.1097/pec.0000000000001951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To show the efficacy of cartoon as a distraction technique in suturing a child patient in the emergency room. METHODS We studied children aged 2 to 8 years who had sustained a facial laceration 3 cm or less that required suturing from September 2015 to November 2016. We used local anesthesia and attempted to place the sutures without sedation while showing the children cartoons instead. If the first attempt failed, 1 more attempt was made. The patients were divided into 3 groups: success, success on second attempt, and failure. Age, location and size of the wound, and scores on the FACES Pain Rating Scale (FPS) before and after local anesthesia were recorded. RESULTS The study included 106 children. Cartoon distraction was most effective for those aged 3 to 6 years (4.6 ± 1.9 years). The second-attempt group tended to be older, whereas the failure group was much younger (mean age, 7.4 ± 1.0 vs 2.7 ± 1.8 years). The FPS-R score differed widely among the groups. The success group tended to have a low score before and after local anesthetic injection (4.1 ± 2.0 and 3.1 ± 1.3), whereas the second-attempt and failure groups had much higher scores after injection (8.0 ± 1.7 and 8.8 ± 0.8; 5.2 ± 2.6 and 9.3 ± 0.8). CONCLUSIONS Cartoon distraction techniques can reduce the treatment duration and number of assistants, which also makes it appropriate for the emergency room. In addition, our results indicate that the pre-/post-local injection FPS score is a good predictor of success.
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Affiliation(s)
- Hyo Jeong Choi
- From the Department of Emergency Medicine, Bucheon Hospital of Soonchunhyang University, Bucheon, South Korea
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Drendel AL, Brousseau DC, Casper TC, Bajaj L, Alessandrini EA, Grundmeier RW, Chamberlain JM, Goyal MK, Olsen CS, Alpern ER. Opioid Prescription Patterns at Emergency Department Discharge for Children with Fractures. PAIN MEDICINE 2021; 21:1947-1954. [PMID: 32022894 DOI: 10.1093/pm/pnz348] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To measure the variability in discharge opioid prescription practices for children discharged from the emergency department (ED) with a long-bone fracture. DESIGN A retrospective cohort study of pediatric ED visits in 2015. SETTING Four pediatric EDs. SUBJECTS Children aged four to 18 years with a long-bone fracture discharged from the ED. METHODS A multisite registry of electronic health record data (PECARN Registry) was analyzed to determine the proportion of children receiving an opioid prescription on ED discharge. Multivariable logistic regression was performed to determine characteristics associated with receipt of an opioid prescription. RESULTS There were 5,916 visits with long-bone fractures; 79% involved the upper extremity, and 27% required reduction. Overall, 15% of children were prescribed an opioid at discharge, with variation between the four EDs: A = 8.2% (95% confidence interval [CI] = 6.9-9.7%), B = 12.1% (95% CI = 10.5-14.0%), C = 16.9% (95% CI = 15.2-18.8%), D = 23.8% (95% CI = 21.7-26.1%). Oxycodone was the most frequently prescribed opioid. In the regression analysis, in addition to variation by ED site of care, age 12-18 years, white non-Hispanic, private insurance status, reduced fracture, and severe pain documented during the ED visit were associated with increased opioid prescribing. CONCLUSIONS For children with a long-bone fracture, discharge opioid prescription varied widely by ED site of care. In addition, black patients, Hispanic patients, and patients with government insurance were less likely to be prescribed opioids. This variability in opioid prescribing was not accounted for by patient- or injury-related factors that are associated with increased pain. Therefore, opioid prescribing may be modifiable, but evidence to support improved outcomes with specific treatment regimens is lacking.
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Affiliation(s)
| | | | | | - Lalit Bajaj
- University of Colorado, Children's Hospital Colorado, Colorado
| | | | - Robert W Grundmeier
- University of Pennsylvania, Children's Hospital of Philadelphia, Pennsylvania
| | - James M Chamberlain
- Children's National Medical Center, The George Washington University, Washington, DC
| | - Monika K Goyal
- Children's National Medical Center, The George Washington University, Washington, DC
| | | | - Elizabeth R Alpern
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago for The Pediatric Emergency Care Applied Research Network (PECARN), Chicago, Illinois, USA
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Frasier K, Burker E, Chan DV. Tablet therapy as an assistive technology-based treatment for anxiety in pediatric oncology. Assist Technol 2021; 34:533-542. [PMID: 33544063 DOI: 10.1080/10400435.2021.1884919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The painful interventions and invasive procedures associated with pediatric cancer treatment can result in anxiety. Anxiety can be reduced or better controlled through distraction and thought retraining. Although art therapy, non-electronic play therapy, music therapy, and traditional counseling are often used to alleviate stress and anxiety, new technology innovations are proving to be additional options to decrease stress and anxiety through distraction and attention shifting. Tablet-based interventions are emerging as an easily available and effective means of reducing stress and fear prior to operations, and have potential applications to reduce anxiety for patients before receiving chemotherapy, during time spent in hospital rooms, and while experiencing distressing physiological symptoms. This paper reviews the research on tablet therapy and discusses the application of assistive technologies in clinical oncology settings to reduce pediatric anxiety throughout the treatment process.
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Affiliation(s)
- Kelly Frasier
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eileen Burker
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dara V Chan
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Goldman RD, Behboudi A. Virtual reality for intravenous placement in the emergency department-a randomized controlled trial. Eur J Pediatr 2021; 180:725-731. [PMID: 32779029 DOI: 10.1007/s00431-020-03771-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
This study sought to determine whether adding virtual reality (VR) was superior to standard of care alone in facilitating reduction in pain and anxiety among children who underwent intravenous catheterization in the emergency department (ED). Sixty-six children aged 6-16 years who needed intravenous placement received VR, or standard of care in the ED (videos, television, iPad, child life specialist). Outcome measures included change in pain score, level of anxiety, patient and parent satisfaction (pain and anxiety), number of trials, and procedure time. Compared with controls, the intervention group had similar age, sex, number of trials, and anesthetic use. Time of procedure was shorter in the VR group (median 5 min) but this was not statistically significant compared with 7 min for the control group. Pain in the intervention group was lower, even before the procedure. Difference in pain (before and after) and anxiety (after the procedure) were similar in both groups. Satisfaction from anxiety management was higher for the VR group (p < 0.007) and children rated VR significantly more "fun" (p < 0.024).Conclusion: VR was an effective distraction tool and increased satisfaction from anxiety management for this common pediatric procedure, and should be incorporated in management of anxiety in children in the ED setting.Trial registration: clinicaltrials.gov ID NCT03681730, https://clinicaltrials.gov/ct2/show/NCT03681730 What is Known: • Virtual reality is an evolving computer technology that shows some promise in the areas of acute and chronic pain management due to its ability to create effective distraction. What is New: • We report that among children in the emergency setting with intravenous catheterization, satisfaction from the use of VR for anxiety management should support implementation of VR systems for this procedure.
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Affiliation(s)
- Ran D Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Amir Behboudi
- Emergency Medicine, Peace Arch Hospital, White Rock, BC, Canada
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12
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Gaba M, Vazquez H, Homel P, Likourezos A, See F, Thompson J, Rizkalla C. Language Barriers and Timely Analgesia for Long Bone Fractures in a Pediatric Emergency Department. West J Emerg Med 2021; 22:225-231. [PMID: 33856304 PMCID: PMC7972388 DOI: 10.5811/westjem.2020.9.48431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Long bone fractures are common painful conditions often managed in the pediatric emergency department (PED). Delay to providing effective pediatric pain management is multifactorial. There is limited information regarding how the issue of language spoken impacts the provision of adequate and timely institution of analgesia. We sought to determine whether there is a difference between English-speaking and non-English speaking patients with respect to time to pain management for long bone fractures in a multi-ethnic urban PED. Methods We conducted a retrospective cohort study of consecutive cases over 29 months of children <18 years old who presented to the PED with a first-time long bone fracture. A correlation of multiple clinical variables with timeliness to providing analgesia as a primary outcome was determined. We performed regression analysis to eliminate confounding and to determine the magnitude of each variable’s effect on the outcome. Results We analyzed a total of 753 patient cases (power 0.95). Regression analysis showed that the variable of English vs non-English language spoken was the most significant predictor of timeliness to pain management (p < 0.001). There was a significant difference in median time to triage measurement of pain score (1 minute vs 4 minutes for English vs non-English speakers [p < 0.001]); median time to initial analgesia (4 minutes vs 13 minutes for English vs non-English speakers (p < 0.001]); and median time to opioid analgesia (32 minutes vs 115 minutes for English vs non-English speakers (p < 0.001]), respectively. All measurements of time were from the creation of a patient’s electronic health record. Just 30% of all patients received an opioid analgesic for treatment of long bone fractures, including only 37% with moderate triage pain scores. Conclusion Delay to receiving analgesic medications in pediatric patients with long bone fractures can be augmented by language barriers. Time to providing analgesia for long bone fractures is significantly delayed in non-English speaking families, contributing to disproportionate care in the PED. Furthermore, use of opioid analgesia for fractures in children remains poor.
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Affiliation(s)
- Michelle Gaba
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Hector Vazquez
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | | | - Antonios Likourezos
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Francis See
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Jess Thompson
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Christine Rizkalla
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
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Páramo-Cano T, Ortiz MI, Gómez-Busto FJ, Espinoza-Ramírez AL. Management of Procedural Pain in Children. Curr Pediatr Rev 2021; 17:288-328. [PMID: 33820520 DOI: 10.2174/1573396317666210405150526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/02/2020] [Accepted: 01/25/2021] [Indexed: 11/22/2022]
Abstract
In recent years, there has been increased interest in the study of pain in children and its treatment. It is known that when facing diagnostic and therapeutic procedures similar to those performed on adults, children either do not receive specific pain treatment or receive it on a significantly lower scale. However, recent research suggests a change in attitude and an improvement in the current treatment of children's pain. Although current knowledge demonstrates the falsity of many preconceived ideas about pain and its management, our results suggest that attitudinal change towards childhood pain remains slow and that real improvement in the training and practical application of the pediatrician who has to treat childhood pain is urgently needed. In this context, this manuscript has prepared standards and guidelines to improve pain management practices in a large number of national and international professional settings.
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Affiliation(s)
- Tatjana Páramo-Cano
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Mario I Ortiz
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Federico J Gómez-Busto
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Ana L Espinoza-Ramírez
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
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Barbour T, O'Keefe S, Mace SE. Topical Refrigerant Spray for IVs: Patient/Provider Responses - Prospective, Double-blind, Randomized Study. West J Nurs Res 2020; 43:762-769. [PMID: 33292081 DOI: 10.1177/0193945920976061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Painful procedures are common. Patients prefer analgesia for painful procedures. Studies indicate that use of a topical refrigerant spray (TRS) prior to needlestick procedures decreases needlestick pain. TRS is easy to apply, inexpensive, has fast onset, and avoids needlestick pain and anxiety, and needlestick injury risk. Patient and health care provider (HCP) acceptance of any technique is essential before it is adopted. This study evaluated the decrease in pain with TRS and the patient and HCP satisfaction and acceptance of TRS for peripheral intravenous (PIV) placement. Adults (N = 300) randomized to placebo or TRS and HCPs (N = 300) placing PIVs answered questionnaires. Patients had significantly less pain than with prior PIVs, and were satisfied with and would use TRS in the future (P < 0.001). HCP felt that patients had significantly (P < 0.001) less pain with TRS than the placebo, and were satisfied with the TRS, and would use TRS in the future.Registered at Clinicaltrials.gov NCT01670487.
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Affiliation(s)
- Tracy Barbour
- Emergency Services Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sharon O'Keefe
- Emergency Services Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sharon E Mace
- Emergency Services Institute, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,MetroHealth Medical Center/Cleveland Clinic Emergency Residency, Cleveland, OH, USA
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Abstract
Painful diagnostic and therapeutic procedures are common in the emergency department. Adequately treating pain, including the pain of procedures is an essential component of the practice of emergency medicine. Pain management is also part of the core competency for emergency medicine residencies and pediatric emergency medicine fellowships. There are many benefits to providing local and/or topical anesthesia before performing a medical procedure, including better patient and family satisfaction and increased procedural success rates. Local and topical anesthetics when used appropriately, generally, have few, if any, systemic side effects, such as hypotension or respiratory depression, which is an advantage over procedural sedation. Use of local and topical anesthetics can do much toward alleviating the pain and anxiety of pediatric patients undergoing procedures in the emergency department.
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Blank KD, Otsuka NY. Pediatric Pain Management in Plastic Surgery. Clin Plast Surg 2020; 47:215-219. [PMID: 32115048 DOI: 10.1016/j.cps.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Adequate pediatric pain management is difficult to achieve for a variety of reasons. Pain assessment is more difficult in the pediatric population. There are a variety of different tools that may be used to accurately assess pain. There are many modalities to achieve pain control, including pharmacologic and nonpharmacologic means. These different modalities should be used in unison to achieve pain control. Compartment syndrome is a surgical emergency, and pediatric patients present differently from adult patients. The 3 As (anxiety, agitation, increase in analgesia requirement) should be monitored in all pediatric patients.
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Affiliation(s)
- Kory D Blank
- Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Norman Y Otsuka
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Street, 5th Floor, Springfield, IL 62702, USA
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Mullapally SK. Midazolam Orally for Sedation during Pediatric Intrathecal Chemotherapy: Unmet Need of Distress-Free Procedures for Cancer Kids in India. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_225_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractPreprocedural sedation is the part of standard operating procedures for pediatric intrathecal chemotherapy in developed countries and uses predominantly intravenous route. In India, due to the limited availability of pediatric oncology facilities and the increased patient numbers at those centers, no such intervention is possible. This article discusses this issue and proposes the use of oral midazolam in this context for large-scale utilization.
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Noble J, Zarling B, Geesey T, Smith E, Farooqi A, Yassir W, Sethuraman U. Analgesia Use in Children with Acute Long Bone Fractures in the Pediatric Emergency Department. J Emerg Med 2020; 58:500-505. [DOI: 10.1016/j.jemermed.2019.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 01/30/2023]
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Ranieri J, Guerra F, Cilli E, Di Giacomo D. An Integrated Approach for a New Pattern in Pediatric Primary Care: Interaction Mediation for Active and Efficient Medical Consultations. Front Pediatr 2020; 8:530. [PMID: 33014931 PMCID: PMC7499798 DOI: 10.3389/fped.2020.00530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: This study analyzed the impact of an innovative integrated approach in pediatric care on children's behavior and cooperation during care. Methods: The participants included 75 children aged 3-8 years (30 girls and 45 boys) recruited from a pediatric surgery department. The sample was categorized into three groups according to experimental condition: the Control, Playing, and Interaction groups. Results: A one-way ANOVA revealed significant differences in cooperation between the three groups [F (2,1) = 5.52; p = 0.006]. A post-hoc analysis showed better performance in the Interaction group (p = 0.002) compared to the Control group during clinical care. The Control group also showed less cooperation compared to the Playing group (p = 0.009). Conclusions: The findings indicate that distraction before medical care can positively influence children's behavior, increasing their cooperation in medical settings. Future studies could objectively analyze physiological changes in children during medical care to better relieve anxiety and provide them with more efficient care.
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Affiliation(s)
- Jessica Ranieri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federica Guerra
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Eleonora Cilli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Dina Di Giacomo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Safety and effectiveness of chloral hydrate in outpatient paediatric sedation for objective hearing tests. Int J Pediatr Otorhinolaryngol 2019; 126:109605. [PMID: 31369972 DOI: 10.1016/j.ijporl.2019.109605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Chloral hydrate is a sedative that has been used for many years in clinical practice and, under proper conditions, gives a deep and long enough sleep to allow performance of objective hearing tests in young children. The reluctance to use this substance stems from side effects reported over time that can vary, depending on dose, procedure settings and immediate life supporting intervention when needed. Our study adds to those that have appeared in recent years, showing that chloral hydrate is an effective and safe substance when is used in proper conditions. METHODS The study included 322 children who needed sedation for objective hearing tests, from April 2014 to March 2018. Parents were instructed to bring the child tired and fasted for at least 2 h before sedation. The sedative was administered by trained staff in the hospital, and the child was monitored until awaking. RESULTS In our study group, over half of the children were in the age 1-4 years group, and only 15% were older than 4 years. The dose of chloral hydrate ranged between 50 and 83 mg/kg body weight, with an average of 75 mg. Successful sedation occurred in 94.1% of children; 0.9% of children awoke during testing and required supplemental sedation or rescheduling of the testing. The most common side effects were vomiting, agitation, prolonged sleep, and failure to fall asleep. CONCLUSIONS Comparing the side effects of chloral hydrate in our study with those from other studies, ours were similar to those described in the literature. In our study chloral hydrate was effective and had only limited adverse effects. The use of chloral hydrate under hospital conditions with proper monitoring could be a practical and safe solution for outpatients or those with short-term hospitalisation.
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News of the Academy of Neonatal Nursing. Neonatal Netw 2019; 37:126-132. [PMID: 29615161 DOI: 10.1891/0730-0832.37.2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pain Assessment in Children Younger Than 8 Years in Out-of-Hospital Emergency Medicine: Reliability and Validity of EVENDOL Score. Pediatr Emerg Care 2019; 35:125-131. [PMID: 28030517 DOI: 10.1097/pec.0000000000000953] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pain in children is underestimated and undertreated in out-of-hospital emergency medicine. In this setting, caregivers need a reliable pain scale, but none has been validated. A single observational pain scale for all children younger than 8 years, EVENDOL, has been validated in emergency pediatric units. We study the feasibility of EVENDOL score in an out-of-hospital emergency setting. METHODS This prospective multicenter study included all conscious children younger than 8 years transported by a mobile intensive care unit between October 2008 and May 2010. The emergency physician and nurse independently assessed the child's pain using first a numeric rating scale (score 0-10), then the 5-item EVENDOL scale (verbal/vocal expression, facial expression, movements, postures, and relationship with entourage) (score 0-3/item) at 3 time points (at rest, during examination, and after analgesia). We studied the scale's internal validity, interrater reliability, discriminant ability (influence of fever and anxiety), and face validity. RESULTS Of the 422 included children, 82 and 62 (29%-39%) were in pain according to the emergency physician and nurses (numeric rating scale >3/10). All EVENDOL scale attributes were satisfied at all 3 time points, for all population subsets. Values for the first assessment (entire study population) were as follows: internal validity (0.78-0.89), interrater reliability (r = 0.63-0.76, weighted κ = 0.49-0.65), construct validity, and discriminant ability (r = 0.6-0.7). Fever did not impact on EVENDOL score. Anxiety level and pain were correlated. Completion time was fast (mean, 2.3-3.4 minutes). Face validity was good. CONCLUSION EVENDOL is a quick, easy-to-use, discriminant instrument to assess pain in young children in out-of-hospital emergency settings.
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Ali S, Sivakumar M, Beran T, Scott SD, Vandermeer B, Curtis S, Jou H, Hartling L. Study protocol for a randomised controlled trial of humanoid robot-based distraction for venipuncture pain in children. BMJ Open 2018; 8:e023366. [PMID: 30552264 PMCID: PMC6303653 DOI: 10.1136/bmjopen-2018-023366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Intravenous insertion (IVI) is a very common procedure in the emergency department (ED). IVI is often painful and stressful for both children and their families. Currently, distraction therapy is not used as a standard of care for IVI in North America. We propose that interaction with a humanoid robot may effectively distract children during IVI thereby reducing their pain and distress. METHODS AND ANALYSIS This randomised controlled superiority trial will be conducted in a Canadian paediatric ED. We plan to recruit 80 patients. Children will be eligible if they (1) are 6 to 11 years of age, (2) need an IVI, (3) are fully conscious and alert, (4) have sufficient knowledge of the English language to understand and complete the study assessments and (5) are accompanied by a legal guardian. Our primary objective is to compare patient-reported pain and distress with the use of distraction (via a humanoid robot) versus standard care in children. The primary outcomes will be (1) self-reported pain, as measured by the Faces Pain Scale-Revised and (2) observed distress, as measured by the Observational Scale of Behavioural Distress-Revised. Secondary outcomes will include (1) measuring parental anxiety, (2) examining the association between parental anxiety and child outcomes and (3) children's degree of engagement with the humanoid robot via the Intrinsic Motivation Inventory tool. First enrolment occurred in April 2017 and is ongoing. ETHICS AND DISSEMINATION This study has been approved by the Health Research Ethics Board (University of Alberta). Informed consent to participate will be obtained from all participants' parents/guardian, in conjunction with assent from the participant themselves. This study data will be submitted for publication regardless of results. Purchase of the robot was facilitated through a Stollery Children's Hospital Foundation donation. Recruitment costs are supported by the Women and Children's Health Research Institute. TRIAL REGISTRATION NUMBER NCT02997631; Pre-results.
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Affiliation(s)
- Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women & Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Mithra Sivakumar
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tanya Beran
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ben Vandermeer
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Curtis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women & Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Hsing Jou
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
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Martin HA. The Power of Topical Anesthetics and Distraction for Peripheral Intravenous Catheter Placement in the Pediatric Perianesthesia Area. J Perianesth Nurs 2018; 33:880-886. [DOI: 10.1016/j.jopan.2017.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/11/2017] [Accepted: 08/27/2017] [Indexed: 10/18/2022]
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Ameri M, Aghakhani K, Memarian A, Ameri E. Epidemiology of sport trauma: a prospective study. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2018. [DOI: 10.23736/s0393-3660.18.03685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schoolman-Anderson K, Lane RD, Schunk JE, Mecham N, Thomas R, Adelgais K. Pediatric emergency department triage-based pain guideline utilizing intranasal fentanyl: Effect of implementation. Am J Emerg Med 2018; 36:1603-1607. [DOI: 10.1016/j.ajem.2018.01.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 10/18/2022] Open
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Setlur A, Friedland H. Treatment of pain with intranasal fentanyl in pediatric patients in an acute care setting: a systematic review. Pain Manag 2018; 8:341-352. [PMID: 30278812 DOI: 10.2217/pmt-2018-0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The primary objective of this review is to provide an updated, comprehensive overview on the efficacy of intranasal fentanyl (INF) for acute pain relief in the pediatric population. METHODS Utilizing the Preferred Reporting Instructions for Systematic Reviews and Meta-Analyses (PRISMA), we were able to screen articles based on key words to reach a final number of 10 studies. RESULTS All but one study showed that INF was efficacious for pain relief in this select pediatric population. CONCLUSION It is evident that INF is efficacious for analgesia, but other agents should also be considered in this patient population. As a result, further research is needed to investigate the clinically efficacy of INF in an acute care setting for pediatric patients.
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Affiliation(s)
- Anuradha Setlur
- Department of Pediatrics, St. Joseph's Medical Center, Paterson, NJ 07503, USA
| | - Howard Friedland
- Department of Pediatrics, St. Joseph's Medical Center, Paterson, NJ 07503, USA
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Barbour T, O'Keefe S, Mace SE. Patient and Health Care Provider Responses from a Prospective, Double-Blind, Randomized Controlled Trial Comparing Vapocoolant Spray versus Placebo Spray in Adults Undergoing Venipuncture in the Emergency Department. Pain Manag Nurs 2018; 19:391-399. [DOI: 10.1016/j.pmn.2017.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 11/26/2022]
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Trottier ED, Ali S, Thull-Freedman J, Meckler G, Stang A, Porter R, Blanchet M, Dubrovsky AS, Kam A, Jain R, Principi T, Joubert G, Le May S, Chan M, Neto G, Lagacé M, Gravel J. Treating and reducing anxiety and pain in the paediatric emergency department-TIME FOR ACTION-the TRAPPED quality improvement collaborative. Paediatr Child Health 2018; 23:e85-e94. [PMID: 30046273 PMCID: PMC6054215 DOI: 10.1093/pch/pxx186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES In 2013, the TRAPPED-1 survey reported inconsistent availability of pain and distress management strategies across all 15 Canadian paediatric emergency department (PEDs). The objective of the TRAPPED-2 study was to utilize a procedural pain quality improvement collaborative (QIC) and evaluate the number of newly introduced pain and distress-reducing strategies in Canadian PEDs over a 2-year period. METHODS A QIC was created to increase implementation of new strategies, through collaborative information sharing among PEDs. In 2015, 11 of the 15 Canadian PEDs participated in the TRAPPED QIC. At the end of the year, the TRAPPED-2 survey was electronically sent to a representative member at each of the 15 PEDs. The successful introduction of the chosen strategies by the QIC was assessed as well as the addition of new strategies per site. The number of new strategies introduced in the participating and nonparticipating QIC sites were described. RESULTS All 15 PEDs (100%) completed the TRAPPED-2 survey. Overall, 10/11 of QIC-participating sites implemented the strategy they had initially identified. All 15 Canadian PEDs implemented some new strategies during the study period; participants in the QIC reported a mean of 5.2 (1-11) new strategies compared to 2.5 (1-4) in the nonactively participating sites. CONCLUSION While all PEDs introduced new strategies during the study, QIC-participating sites successfully introduced the majority of their previously identified new strategies in a short time period. Sharing deadlines and information between centres may have contributed to this success.
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Affiliation(s)
| | - Samina Ali
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta
| | | | - Garth Meckler
- BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Antonia Stang
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta
| | - Robert Porter
- Janeway Children’s Hospital, Memorial University, St-Johns, Newfoundl
| | | | | | - April Kam
- McMaster Children’s Hospital, McMaster University, Hamilton, Ontario
| | | | - Tania Principi
- Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | | | - Sylvie Le May
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec
| | - Melissa Chan
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta
| | - Gina Neto
- CHEO, University of Ottawa, Ottawa, Ontario
| | - Maryse Lagacé
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec
| | - Jocelyn Gravel
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec
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Glauser J, Money S. Medical Management of Pain in the Emergency Setting Without Narcotics: Current Status and Future Options. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Nearly 20 years ago, standards were established for hospitals to assess and treat pain in all patients. Research continues to demonstrate evolving trends in the measurement and effective treatment of pain in children. Behavioral research demonstrating long-lasting effects of inadequate pain control during childhood supports the concepts of early and adequate pain control for children suffering from painful conditions in the acute care setting. The authors discuss pain concepts, highlighting factors specific to the emergency department, and include a review of evidence for pharmacologic and nonpharmacologic treatments.
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Drendel AL, Ali S. Ten Practical Ways to Make Your ED Practice Less Painful and More Child-Friendly. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Safe and Rational Use of Analgesics: Non-Opioid Analgesics Alternatives to the Use of Narcotics in Emergency Pain Management. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stoltz P, Manworren RCB. Comparison of Children's Venipuncture Fear and Pain: Randomized Controlled Trial of EMLA® and J-Tip Needleless Injection System®. J Pediatr Nurs 2017; 37:91-96. [PMID: 28823623 DOI: 10.1016/j.pedn.2017.08.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 07/27/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Needle procedures, like venipuncture and intravenous (IV) catheter insertion, are recognized as a common cause of pain and fear for children in hospitals and emergency departments. The purpose of this study was to compare children's self-reported pain and fear related to IV insertion with administration of either the topical local anesthetic EMLA® or 1% buffered lidocaine delivered with the J-Tip Needleless Injection System® (J-Tip®). DESIGN AND METHODS In this prospective, randomized trial, 150 consecutive pediatric patients 8 to 18years of age undergoing IV insertion were randomly assigned 1:1 to treatment group. Participants self-reported procedural pain using a Visual Analog Scale, and procedural fear using the Children's Fear Scale. RESULTS Procedural pain scores were significantly lower in the EMLA® group (mean score 1.63+1.659) vs. the J-Tip® group (2.99±2.586; p<0.001). Post-procedure fear scores were significantly lower than pre-procedure fear scores in both treatment groups (p<0.002), but there was no difference in fear scores between the two treatment groups (p=0.314). CONCLUSION EMLA® provided superior pain relief for IV insertion compared to J-Tip®. PRACTICE IMPLICATIONS Although EMLA® use resulted in lower self-reported pain scores compared to J-Tip®, pain scores for both treatments were low and fear scores did not differ. When IV insertion can be delayed for 60-90min, EMLA® should be used. When a delay is contraindicated, J-Tip® may be a reasonable alternative to minimize procedural pain of IV insertion.
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Affiliation(s)
- Petronella Stoltz
- Division of Pediatric Critical Care, Connecticut Children's Medical Center, Hartford, CT, United States; Division of Pediatric Neurosurgery, Connecticut Children's Medical Center, Hartford, CT, United States.
| | - Renee C B Manworren
- Nursing Research & Professional Practice, Posey and Fred Love Chair in Nursing Research, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; (d)Northwestern University Feinberg School of Medicine, United States.
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Abstract
BACKGROUND Nonnutritive sucking using a finger or pacifier is a natural reflex for infants. We hypothesized that infants may overfeed if the bottle or breast is constantly offered. Our goal was to determine whether pacifier use in early infancy is associated with lower incidence of obesity at later age. METHODS Parents of 399 infants, 9 to 15 months old, were interviewed and asked whether a pacifier was used consistently for ≥9 months. Body mass indexes at birth, 6 months, and on the day of interview were calculated. RESULTS In all, 204 (51%) infants used a pacifier, and 195 (49%) were nonusers. More infants in the nonuser group were either overweight-40 (21%)-or obese-32 (16%)-than in the user group-22 (11%) and 22 (11%), respectively ( P = .003). CONCLUSIONS Pacifier use in infancy was associated with lower incidence of obesity at 9 to 15 months of age. Offering a pacifier can be protective against infantile obesity.
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Affiliation(s)
- Ahdi Amer
- 1 Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Xiaoming Li
- 3 University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Howard Fischer
- 1 Wayne State University School of Medicine, Detroit, MI, USA
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Gates A, Shave K, Featherstone R, Buckreus K, Ali S, Scott S, Hartling L. Parent experiences and information needs relating to procedural pain in children: a systematic review protocol. Syst Rev 2017; 6:109. [PMID: 28587663 PMCID: PMC5461670 DOI: 10.1186/s13643-017-0499-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 05/11/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There exist many evidence-based interventions available to manage procedural pain in children and neonates, yet they are severely underutilized. Parents play an important role in the management of their child's pain; however, many do not possess adequate knowledge of how to effectively do so. The purpose of the planned study is to systematically review and synthesize current knowledge of the experiences and information needs of parents with regard to the management of their child's pain and distress related to medical procedures in the emergency department. METHODS We will conduct a systematic review using rigorous methods and reporting based on the PRISMA statement. We will conduct a comprehensive search of literature published between 2000 and 2016 reporting on parents' experiences and information needs with regard to helping their child manage procedural pain and distress. Ovid MEDLINE, Ovid PsycINFO, CINAHL, and PubMed will be searched. We will also search reference lists of key studies and gray literature sources. Two reviewers will screen the articles following inclusion criteria defined a priori. One reviewer will then extract the data from each article following a data extraction form developed by the study team. The second reviewer will check the data extraction for accuracy and completeness. Any disagreements with regard to study inclusion or data extraction will be resolved via discussion. Data from qualitative studies will be summarized thematically, while those from quantitative studies will be summarized narratively. The second reviewer will confirm the overarching themes resulting from the qualitative and quantitative data syntheses. The Critical Appraisal Skills Programme Qualitative Research Checklist and the Quality Assessment Tool for Quantitative Studies will be used to assess the quality of the evidence from each included study. DISCUSSION To our knowledge, no published review exists that comprehensively reports on the experiences and information needs of parents related to the management of their child's procedural pain and distress. A systematic review of parents' experiences and information needs will help to inform strategies to empower them with the knowledge necessary to ensure their child's comfort during a painful procedure. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016043698.
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Affiliation(s)
- Allison Gates
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Kassi Shave
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Kelli Buckreus
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Women and Children's Health Research Institute, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Shannon Scott
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada. .,Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
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Impact of an Offline Pain Management Protocol on Prehospital Provider Self-Efficacy: A Randomized Trial. Pediatr Emerg Care 2017; 33:388-395. [PMID: 27077996 DOI: 10.1097/pec.0000000000000657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pain in children is inadequately treated in the prehospital setting despite the reported recognition by prehospital providers (PHPs) of pain treatment as an important part of patient care. The impact of pediatric pain management protocol (PPP) implementation on PHP self-efficacy (SE), a measure congruent with performance, is unknown. OBJECTIVE The aim of this study was to evaluate the impact of PPP implementation and pain management education on PHP SE. METHODS This was a prospective study evaluating the change in PHP SE after a PPP was implemented. Prehospital providers were randomized to 3 groups: protocol introduction alone, protocol introduction with education, and protocol introduction with education and a 3-month interim review. Prehospital provider SE was assessed for pain management given 3 age-based scenarios. Self-efficacy was measured with a tool that uses a ranked ordinal scale ranging from "certain I cannot do it" (0) to "completely certain I can do it" (100) for 10 pain management actions: pain assessment (3), medication administration (4), dosing (1), and reassessment (2). An averaged composite score (0-100) was calculated for each of the 3 age groups (adult, child, toddler). Paired-sample t tests compared post-PPP and 13-month scores to pre-PPP scores. RESULTS Of 264 PHPs who completed initial surveys, 142 PHPs completed 13-month surveys. Ninety-three (65%) received education with protocol review, and 49 (35%) had protocol review only. Self-efficacy scores increased over the study period, most notably for pain assessment. This increase persisted at 13 months for child (6.6 [95% confidence interval {CI}, 1.4-11.8]) and toddler pain assessment (22.3 [95% CI, 16.4-28.3]). Composite SE scores increased immediately for all age groups (adult, 3.1 [95% CI, 1.3-4.9]; child, 6.1 [95% CI, 3.8-8.5]; toddler, 12.0 [95% CI, 9.5-14.5]) and persisted at 13 months for the toddler group alone (7.0 [95% CI, 4.3-9.7]). There was no difference between groups who received protocol review alone compared with those with education or education plus a 3-month interim review. CONCLUSIONS After a pain management protocol was introduced, SE scores among PHPs increased immediately and remained elevated for some individual actions involved in pain management, most notably pain assessment. Prehospital provider pain assessment SE scores declined 13 months after protocol introduction for adults, but remained elevated compared with baseline for the pediatric age groups.
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Agarwal R, Riefe J, Houck CS. Fifty years of the American Academy of Pediatrics Section on Anesthesiology: a history of our specialty. Paediatr Anaesth 2017; 27:560-570. [PMID: 28332249 DOI: 10.1111/pan.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2017] [Indexed: 11/26/2022]
Abstract
The American Academy of Pediatrics Section on Anesthesiology and Pain Medicine celebrated its 50th Anniversary in 2015. The Section was one of the first and only subspecialty organizations in anesthesiology at the time. This special article will focus on the contributions of the Section to the practice of pediatric anesthesiology in the areas of advocacy, education and member contributions. In 1986, the Section created the Robert M. Smith Award to honor those members who had made significant advances in the practice of pediatric anesthesiology. It is named after one of the Section founders, an influential educator, inventor, and researcher in our field. We will focus the latter part of the article on the Robert M. Smith award winners to illustrate the contributions of the Section and its members to the development of the field of pediatric anesthesiology.
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Affiliation(s)
- Rita Agarwal
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer Riefe
- Section on Anesthesiology and Pain Medicine, American Academy of Pediatrics, Elk Grove Village, IL, USA
| | - Constance S Houck
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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Olsen K, Weinberg E. Pain-Less Practice: Techniques to Reduce Procedural Pain and Anxiety in Pediatric Acute Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
OBJECTIVES The aim of the present cohort study was to evaluate the influence of a novel pacifier on the first formation of malocclusion, the anterior open bite in children. STUDY DESIGN 129 newborn children whose parents had decided to use pacifiers were randomly attributed to two experimental groups (D=Dentistar, n=56, Novatex, Pattensen, Germany; N=NUK, n=73, Mapa, Zeven, Germany). Children (n=42) who did not use a pacifier were not randomized and served as reference (C). Primary outcome was the presence of anterior open bite. It was hypothesized that D would result in lower incidence when compared to N. At the age of 27 months the children were examined with respect to anterior open bite. Fisher's exact test served to detect significant differences between groups D and N (SPSS 22.0). RESULTS 121 children with a mean age of 26.7 months were included in the final analysis (D: n=45; N: n=42; C: n=34). In group D three children (6.7%) showed an anterior open bite. The respective values were 21 (50.0%) for N and 0 for C. The results for group D compared to N were significantly different (chi(2)-test, p<0.001). CONCLUSION In comparison to a commonly used pacifier the novel one causes significantly less anterior open bites.
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How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review. Pain Res Manag 2016; 2016:5346819. [PMID: 28077923 PMCID: PMC5203901 DOI: 10.1155/2016/5346819] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 10/18/2016] [Accepted: 10/27/2016] [Indexed: 11/18/2022]
Abstract
Background. Fear of adverse events and occurrence of side effects are commonly cited by families and physicians as obstructive to appropriate use of pain medication in children. We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (<18 years) treated in ambulatory settings. Methods. A comprehensive search was performed to July 2015, including review of national data registries. Two reviewers screened articles for inclusion, assessed methodological quality, and extracted data. Risks (incidence rates) were pooled using a random effects model. Results. Forty-four studies were included; 23 reported on adverse events. Based on limited current evidence, acetaminophen, ibuprofen, and opioids have similar nausea and vomiting profiles. Opioids have the greatest risk of central nervous system adverse events. Dual therapy with a nonopioid/opioid combination resulted in a lower risk of adverse events than opioids alone. Conclusions. Ibuprofen and acetaminophen have similar reported adverse effects and notably less adverse events than opioids. Dual therapy with a nonopioid/opioid combination confers a protective effect for adverse events over opioids alone. This research highlights challenges in assessing medication safety, including lack of more detailed information in registry data, and inconsistent reporting in trials.
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Horst J, Frei-Jones M, Deych E, Shannon W, Kharasch ED. Pharmacokinetics and analgesic effects of methadone in children and adults with sickle cell disease. Pediatr Blood Cancer 2016; 63:2123-2130. [PMID: 27572136 PMCID: PMC5411015 DOI: 10.1002/pbc.26207] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Vaso-occlusive episodes (VOEs) are a significant source of morbidity among children and adults with sickle cell disease (SCD). There is little information on methadone use for SCD pain. This investigation evaluated methadone pharmacokinetics in children and adults with SCD, with a secondary aim to assess pain relief and opioid consumption. PROCEDURE Participants included children (<18 years) and adults with a VOE requiring hospitalization. Patients were randomly assigned to receive standard care (opioid patient-controlled analgesia; control group) or one dose of intravenous methadone (0.1-0.125 mg/kg) in addition to standard care (methadone group). Venous methadone and metabolite concentrations were measured. Pain scores, pain relief scores, and opioid consumption were recorded. RESULTS Twenty-four children (12 methadone, 12 controls) and 23 adults (11 methadone, 12 controls) were studied. In children, the half-life of R- and S-methadone enantiomers was 34 ± 16 and 24 ± 9 hr, respectively. In adults, R- and S-methadone half-lives were 52 ± 17 and 38 ± 12 hr, respectively. Pain scores were lower (P = 0.002) and pain relief scores were higher (P = 0.0396) in children receiving methadone versus controls. There was no difference in pain scores and pain relief in adults receiving methadone versus controls. There was no difference in opioid consumption between methadone and control groups, in both adults and children. CONCLUSIONS Intravenous methadone disposition in children and adults with SCD was comparable to that in subjects without SCD from prior studies. Methadone produced more pain relief than standard care in children with SCD. Higher methadone doses may be more effective and should be evaluated in both children and adults with SCD.
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Affiliation(s)
- Jennifer Horst
- Department of Pediatrics, Washington University in St. Louis
| | | | - Elena Deych
- Department of Internal Medicine, Washington University in St. Louis
| | - William Shannon
- Department of Internal Medicine, Washington University in St. Louis
| | - Evan D. Kharasch
- Department of Anesthesiology, Washington University in St. Louis,Department of Biochemistry and Biophysics, Washington University in St. Louis,The Center for Clinical Pharmacology, St. Louis College of Pharmacy and Washington University School of Medicine
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Improving the Treatment and Assessment of Moderate and Severe Pain in a Pediatric Emergency Department. Pain Res Manag 2016; 2016:4250109. [PMID: 27672348 PMCID: PMC5031872 DOI: 10.1155/2016/4250109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/21/2016] [Indexed: 11/28/2022]
Abstract
Background. The Janeway Children's Hospital previously enacted a number of measures to improve pain management for patients in its emergency department (ED). While improvements were demonstrated, rates for the timely assessment and treatment of pain remain below standards of care. Objectives. The study objectives are to investigate the impact of the previous attempts to improve the treatment of pain and to explore ways to further improve pain management in the ED. Methods. Key informant interviews and a focus group were conducted with nurses, physicians, and parents whose children were identified as having severe pain. Results. Interviews were conducted with 31 parents or children, 9 physicians, and 8 nurses. The focus group was attended by 15 nurses. Previous initiatives were viewed as improvements. Continued barriers include difficulties in accurately capturing the level of pain, issues in treating pain for specific types of patients, and inadequacy in addressing patients in severe pain. Conclusion. Changes in pain treatment protocols can result in positive impacts but are likely insufficient on their own to achieve desired standards of care. Consistent measurement and engagement with staff can identify additional opportunities for improving pain management within an ED setting.
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Appendicitis and Analgesia in the Pediatric Emergency Department: Are We Adequately Controlling Pain? Pediatr Emerg Care 2016; 32:581-4. [PMID: 26466149 DOI: 10.1097/pec.0000000000000573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The primary objective of the study was to compare analgesia-prescribing practices and timing of analgesia administration between pediatric emergency medicine (PEM) and general emergency medicine (GEM) practitioners for children with appendicitis. The secondary objective was to compare analgesia administration versus triage pain score, pediatric appendicitis score (PAS), and body mass index (BMI). METHODS This was a retrospective chart review of patients younger than 21 years who presented to either an urban pediatric emergency department (ED) or 2 general EDs and were diagnosed with appendicitis. RESULTS Two hundred eighteen charts were reviewed, 153 (70%) from the pediatric ED and 65 (30%) from the general EDs. The patients seen by PEM physicians were younger than the patients seen by GEM physicians (mean age, 12.8 vs 15.4 years; P = 0.002). The patients evaluated by GEM physicians were more likely to receive analgesia in the ED (82% vs 60%, P = 0.003) and received analgesia sooner (mean, 178 vs 239 minutes; P = 0.026) than the patients evaluated by PEM physicians. The patients with triage pain scores higher than 6 of 10 were more likely to receive analgesia than the patients with pain scores lower than 6 (71% vs 51%, P = 0.015). There was no association between PAS or BMI and analgesia administration or time to analgesia (P = not significant). CONCLUSIONS The patients with appendicitis evaluated by GEM physicians were more likely to receive analgesia and receive analgesia quicker than the patients evaluated by PEM physicians. The patients with higher pain scores were more likely to receive analgesia, but PAS and BMI did not affect analgesia administration.
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Mace SE. Prospective, randomized, double-blind controlled trial comparing vapocoolant spray vs placebo spray in adults undergoing venipuncture. Am J Emerg Med 2016; 34:798-804. [DOI: 10.1016/j.ajem.2016.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 10/22/2022] Open
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Dantas LVRP, Dantas TSP, Santana Filho VJ, Azevedo-Santos IF, DeSantana JM. Pain assessment during blood collection from sedated and mechanically ventilated children. Rev Bras Ter Intensiva 2016; 28:49-54. [PMID: 27096676 PMCID: PMC4828091 DOI: 10.5935/0103-507x.20160013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/08/2016] [Indexed: 12/02/2022] Open
Abstract
Objective This study assessed pain and observed physiological parameters in sedated and
mechanically ventilated children during a routine procedure. Methods This observational study was performed in a pediatric intensive care unit.
Thirty-five children between 1 month and 12 years of age were assessed
before, during, and five minutes after an arterial blood collection for gas
analysis (painful procedure). Face, Legs, Activity, Cry and Consolability
scale was used to assess pain. In addition, patients' heart rate,
respiratory rate, peripheral saturation of oxygen and blood pressure
(diastolic and systolic) were recorded. COMFORT-B scale was applied before
the pain and physiological parameter assessments to verify sedation level of
the subjects. Results There was an increase in Face, Legs, Activity, Cry and Consolability score (p
= 0.0001) during painful stimuli. There was an increase in heart rate (p =
0.03), respiratory rate (p = 0.001) and diastolic blood pressure (p = 0.006)
due to pain caused by the routine procedure. Conclusions This study suggests that assessments of pain using standard scales, such as
Face, Legs, Activity, Cry and Consolability score, and other physiological
parameters should be consistently executed to optimize pain management in
pediatric intensive care units.
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Acute Traumatic Pain in the Prehospital and Emergency Department Setting. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0093-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Le May S, Ali S, Khadra C, Drendel AL, Trottier ED, Gouin S, Poonai N. Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review. Pain Res Manag 2016; 2016:4809394. [PMID: 27445614 PMCID: PMC4904632 DOI: 10.1155/2016/4809394] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/03/2015] [Indexed: 12/21/2022]
Abstract
Background. Pain management for children with musculoskeletal injuries is suboptimal and, in the absence of clear evidence-based guidelines, varies significantly. Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries. Methods. Electronic databases were searched systematically for randomized controlled trials of pharmacological and nonpharmacological interventions for children aged 0-18 years, with musculoskeletal injury, in the emergency department. The primary outcome was the risk ratio for successful reduction in pain scores. Results. Of 34 studies reviewed, 8 met inclusion criteria and provided data on 1169 children from 3 to 18 years old. Analgesics used greatly varied, making comparisons difficult. Only two studies compared the same analgesics with similar routes of administration. Two serious adverse events occurred without fatalities. All studies showed similar pain reduction between groups except one study that favoured ibuprofen when compared to acetaminophen. Conclusions. Due to heterogeneity of medications and routes of administration in the articles reviewed, an optimal analgesic cannot be recommended for all pain categories. Larger trials are required for further evaluation of analgesics, especially trials combining a nonopioid with an opioid agent or with a nonpharmacological intervention.
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Affiliation(s)
- Sylvie Le May
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada H3T 1A8
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5
| | - Samina Ali
- Women and Children's Health Research Institute, Edmonton, AB, Canada T6G 1C9
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada T6G 1C9
| | - Christelle Khadra
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada H3T 1A8
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5
- McGill University Health Centre, Montreal, QC, Canada H4A 3J1
| | - Amy L. Drendel
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Evelyne D. Trottier
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5
- Division of Emergency Medicine, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, QC, Canada H3T 1C5
| | - Serge Gouin
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada H3T 1C5
- Division of Emergency Medicine, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, QC, Canada H3T 1C5
| | - Naveen Poonai
- Children's Hospital, London Health Sciences Centre, London, ON, Canada N6A 5W9
- Schulich School of Medicine and Dentistry, London, ON, Canada N6A 5C1
- Child Health Research Institute, London, ON, Canada N6C 2V5
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Glauser J. Pain Management as a Predictor of Patient Satisfaction in the Emergency Department. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Joyner BL, Oden RP, Moon RY. Reasons for Pacifier Use and Non-Use in African-Americans: Does Knowledge of Reduced SIDS Risk Change Parents' Minds? J Immigr Minor Health 2016; 18:402-10. [PMID: 25864091 PMCID: PMC4601923 DOI: 10.1007/s10903-015-0206-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To investigate African-American parental reasons for pacifier use or non-use, and whether knowledge of the association with decreased SIDS risk changes decisions about pacifier use. We conducted focus groups and individual interviews with mothers. Grounded theory methodology was used. 83 mothers participated; 72.3 % of infants used pacifiers. Reasons for pacifier use included comfort/soothing, safety/SIDS, and preference over digit-sucking. Reasons for pacifier non-use included infant refusal, fear of attachment, nipple confusion, and germs. Many parents were unaware that pacifier use reduces SIDS risk; however, most parents of non-users did not think that this knowledge would have changed their decision. Reasons included skepticism about the pacifier-SIDS link. Many reasons underlie African-American parental decisions about pacifier use. Providers should provide information about the benefits of pacifiers. Establishing for parents any plausible link between the protective mechanism of pacifiers and SIDS pathophysiology may be important in promoting pacifier use.
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Affiliation(s)
- Brandi L Joyner
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA
| | - Rosalind P Oden
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA
| | - Rachel Y Moon
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC, USA.
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Division of General Pediatrics and Community Health, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA.
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