1
|
Martin SR, Heyming TW, Valdez BJ, Salas LH, Cohen LL, Fortier MA, Lee K, Kaplan S, Kain ZN. Observational Behavioral Coding in the Pediatric Emergency Department: Development of the Emergency Department Child Behavior Coding System. J Emerg Med 2024; 67:e50-e59. [PMID: 38821846 PMCID: PMC11181611 DOI: 10.1016/j.jemermed.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/06/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Despite improvements over the past decade, children continue to experience significant pain and distress surrounding invasive procedures in the emergency department (ED). To assess the impact of newly developed interventions, we must create more reliable and valid behavioral assessment tools that have been validated for the unique settings of pediatric EDs. OBJECTIVE This study aimed to create and test the Emergency Department Child Behavior Coding System (ED-CBCS) for the assessment of child distress and nondistress behaviors surrounding pediatric ED procedures. METHODS Via an iterative process, a multidisciplinary expert panel developed the ED-CBCS, an advanced time-based behavioral coding measure. Inter-rater reliability and concurrent validity were examined using 38 videos of children aged from 2 to 12 years undergoing laceration procedures. Face, Legs, Activity, Cry, Consolability (FLACC) scale scores were used to examine concurrent validity. RESULTS The final ED-CBCS included 27 child distress and nondistress behaviors. Time-unit κ values from 0.64 to 0.98 and event alignment κ values from 0.62 to 1.00 indicated good to excellent inter-rater reliability for all but one of the individual codes. ED-CBCS distress (B = 1.26; p < 0.001) and nondistress behaviors (B = -0.69, p = 0.025) were independently significantly associated with FLACC scores, indicating concurrent validity. CONCLUSIONS We developed a psychometrically sound tool tailored for pediatric ED procedures. Future work could use this measure to better identify behavioral targets and test the effects of interventions to relieve pediatric ED pain and distress.
Collapse
Affiliation(s)
- Sarah R Martin
- Department of Anesthesiology and Perioperative Care, University of California, Irvine School of Medicine, Irvine, California; Center on Stress and Health, University of California, Irvine, California; Emergency Medicine, Children's Hospital of Orange County, Orange, California.
| | - Theodore W Heyming
- Emergency Medicine, Children's Hospital of Orange County, Orange, California; Department of Emergency Medicine, University of California, Irvine, Orange, California
| | - Brooke J Valdez
- Emergency Medicine, Children's Hospital of Orange County, Orange, California
| | - Luis H Salas
- Emergency Medicine, Children's Hospital of Orange County, Orange, California
| | - Lindsey L Cohen
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Michelle A Fortier
- Department of Anesthesiology and Perioperative Care, University of California, Irvine School of Medicine, Irvine, California; Center on Stress and Health, University of California, Irvine, California; Sue and Bill Gross School of Nursing, University of California, Irvine, California; Children's Hospital of Orange County, Orange, California
| | - Kent Lee
- Emergency Medicine, Children's Hospital of Orange County, Orange, California
| | - Sherrie Kaplan
- Department of Medicine, University of California, Irvine School of Medicine, Irvine, California
| | - Zeev N Kain
- Department of Anesthesiology and Perioperative Care, University of California, Irvine School of Medicine, Irvine, California; Center on Stress and Health, University of California, Irvine, California; Children's Hospital of Orange County, Orange, California; Child Study Center, Yale University, New Haven, Connecticut
| |
Collapse
|
2
|
Kammerer E, Linkiewich D, Ali S. Healthcare professionals' perspectives on optimizing pain care-related education at a Canadian children's hospital: A qualitative study. Paediatr Child Health 2024; 29:163-167. [PMID: 38827367 PMCID: PMC11141606 DOI: 10.1093/pch/pxad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/06/2023] [Indexed: 06/04/2024] Open
Abstract
Objectives Pain affects all children and youth, yet acute and procedural pain remains undertreated in Canadian hospitals. To improve pain management practices in paediatric hospitals, it is necessary to understand how healthcare professionals (HCPs) wish for educational interventions to be designed to improve their pain management practice. Methods Semi-structured interviews were conducted with 18 HCPs between October and December 2020. Snowball sampling was used to first recruit interested members from the hospital's Pediatric Pain Management Committee. Interviews were conducted per participant preference and included Zoom, telephone, and in-person interviews. Recruitment ceased when data were determined sufficiently rich. A thematic analysis of verbatim transcripts and reflexive field notes were used to create a data set focused on knowledge mobilization and clinical education. Results Three core themes were identified: (a) the necessity for just-in-time education for HCPs; (b) the availability of clinical pain champions to educate staff; and (c) the provision of resources to educate children and their families about available pain management interventions. Just-in-time education included suggestions for in-service training, hands-on training, and regular updates on the latest research. Pain champions, including clinical nurse educators, were stressed as being important in motivating staff to improve their pain management practices. Participants noted the lack of resources for patient and family education on pain management and suggested providing more multimodal resources and educational opportunities. Conclusion Having local champions introduce pain management initiatives and just-in-time education positively impacts the implementation climate, which also helps HCPs provide evidence-based education and resources to patients and families.
Collapse
Affiliation(s)
- Elise Kammerer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Delane Linkiewich
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
3
|
Olutoye OO, Eriksson E, Menchaca AD, Kirsner RS, Tanaka R, Schultz G, Weir D, Wagner T, Renata F, Naik-Mathuria B, Liu P, Ead KJ, Adedayo T, Armstrong DG, McMullin N, Balch Samora J, 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] [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.(1) 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 the microcapillary gel, a topical gel embedded with the anti-inflammatory drug infliximab.(38) Additionally, the use of three-dimensional bioprinting and photo-modulation for skin reconstruction following burns is a promising area for continued discovery.
Collapse
Affiliation(s)
- Oluyinka O Olutoye
- Nationwide Children's Hospital, 2650, Surgery, 700 Children's Drive, T6 Administration, Columbus, Columbus, Ohio, United States, 43205
- The Ohio State University, 2647, Surgery, 700 Children's Drive, T6 Administration, Columbus, Ohio, United States, 43210-1132;
| | - Elof Eriksson
- Harvard Medical School, 1811, Plastic & Reconstructive Surgery, Boston, Massachusetts, United States;
| | - Alicia D Menchaca
- Nationwide Children's Hospital, 2650, Pediatric Surgery, 575 Children's Crossroad, Rm 4143, Columbus, Ohio, United States, 43205-2664;
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, United States;
| | - Rica Tanaka
- Juntendo University School of Medicine Graduate School of Medicine, 73362, Regenerative Therapy, Department of Plastic & Reconstructive Surgery, Bunkyo-ku, Tokyo, Japan;
| | - Gregory Schultz
- Institute for Wound Research, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, United States, 32610-0294;
| | - Dot Weir
- Saratoga Hospital for Wound Healing and Hyperbaric Medicine, Saratoga Springs, United States;
| | - Tracey Wagner
- Nationwide Children's Hospital, 2650, Emergency Medicine, Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Fabia Renata
- Nationwide Children's Hospital, 2650, Pediatric Surgery , Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Bindi Naik-Mathuria
- The University of Texas Medical Branch at Galveston, 12338, Pediatric Surgery, Galveston, Texas, United States;
| | - Paul Liu
- Brown University/Rhode Island Hospital, Plastic Surgery, 225 Plain Street, Providence, Rhode Island, United States, 02905;
| | - Karim J Ead
- University of Southern California Keck School of Medicine, 12223, Los Angeles, California, United States;
| | - Temitope Adedayo
- Temple University School of Podiatric Medicine, 70068, Philadelphia, Pennsylvania, United States;
| | - David G Armstrong
- University of Southern California Keck School of Medicine, 12223, Los Angeles, California, United States;
| | - Neil McMullin
- Evans Army Community Hospital, 19909, Plastic Surgery, Fort Carson, Colorado, United States;
| | - Julie Balch Samora
- Nationwide Children's Hospital, 2650, Orthopedic Surgery, Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Ajibola G Akingba
- VA, 8267, Vascular Surgery , Washington, District of Columbia, United States;
| |
Collapse
|
4
|
Haidar NA, Al Amri MH, Sendad NG, Toaimah FHS. Efficacy of Buzzy Device Versus EMLA Cream for Reducing Pain During Needle-Related Procedures in Children: A Randomized Controlled Trial. Pediatr Emerg Care 2024; 40:180-186. [PMID: 37163686 DOI: 10.1097/pec.0000000000002965] [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: 05/12/2023]
Abstract
OBJECTIVES Several pain management tools exist but with limitations in their efficacy or applicability. The EMLA (eutectic mixture of local anesthetics) cream is currently used for pain relief for needle-related procedures; however, it needs a minimum of 30 to 45 minutes to be effective. The Buzzy is a device that generates vibrations with cold leading to quicker pain relief. Our aim was to evaluate the effect of the Buzzy device in pain and anxiety reduction compared with EMLA cream in children requiring intravenous cannulation or venepuncture. METHODS This was a randomized clinical trial comparing pain and anxiety reduction by Buzzy device with the standard care (EMLA cream) in children aged 2 to 14 years who required blood extraction or intravenous cannulation based on their clinical needs. Eligible patients were randomized to either Buzzy device as the intervention or EMLA cream as the control. The outcome measures were the degree of pain scores and anxiety ratings at different stages of the needle-related procedures. RESULTS A total of 300 patients with a mean age of 6.5 ± 3.1 years were enrolled. Baseline characteristics were similar between the Buzzy device and EMLA cream groups. The observed pain scores by research nurses and a parent were significantly lower in the EMLA group compared with the Buzzy device group; however, the pain scores by the self-assessment scale were not statistically significant with mean difference of -0.332, 95% confidence interval, -0.635 to -0.028 ( P = 0.062). The level of anxiety was significantly lower in EMLA compared with Buzzy device ( P = 0. 0.0001). Both staff and parents' satisfaction, success rate of cannulation, type of blood tests, and comment on the physician on the results were similar in both groups. CONCLUSIONS Pain and anxiety relief using the Buzzy device is not as effective as EMLA cream in children requiring venepuncture. However, rapid onset of action of the Buzzy device is valuable in decreasing waiting time in a busy emergency department. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT05354739.
Collapse
Affiliation(s)
- Nasser A Haidar
- From the Pediatric Emergency, Hamad General Hospital, Hamad Medical Corporation (HMC) and College of Medicine, Qatar University, Doha, Qatar
| | - Mohammed H Al Amri
- From the Pediatric Emergency, Hamad General Hospital, Hamad Medical Corporation (HMC) and College of Medicine, Qatar University, Doha, Qatar
| | - Nora G Sendad
- Paediatric Emergency, Hamad General Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Fathi H S Toaimah
- From the Pediatric Emergency, Hamad General Hospital, Hamad Medical Corporation (HMC) and College of Medicine, Qatar University, Doha, Qatar
| |
Collapse
|
5
|
Varghese KS, Ahmed A, Mathew DM, Fusco PJ, Abraham MN. Eutectic mixture of local anesthetics and amethocaine as topical anesthetics in pediatrics: a meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03113-7. [PMID: 38429571 DOI: 10.1038/s41390-024-03113-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Pediatric patients often receive topical anesthesia before skin procedures in the Emergency Department, with EMLA cream and amethocaine gel being common choices. The most effective option remains a subject of debate. OBJECTIVE Our goal was to compare EMLA cream with amethocaine gel in pediatric patients undergoing topical anesthesia, focusing on outcomes: first-attempt cannulation success, child-reported visual analogue scale (VAS) score, parent-reported VAS score, observed pain score, child-reported absence of pain, and child-reported acceptable anesthesia. METHODS A database search for studies comparing EMLA cream and amethocaine gel in pediatric topical anesthesia was conducted. Two reviewers extracted and cross-verified data, with a third ensuring accuracy. Using R software, a pairwise meta-analysis was performed via the Mantel-Haenszel method. Outcomes were pooled as risk ratios or standard mean differences with 95% confidence intervals using the random-effects model. RESULTS Amethocaine gel surpasses EMLA cream in child-reported pain absence and first cannulation success. No significant differences were found in child-reported acceptable anesthesia or observed pain scores. Similarly, child- and parent-reported VAS scores showed no variations between EMLA and amethocaine. CONCLUSION This analysis favors amethocaine gel for pediatric topical anesthesia. Further large randomized trials comparing EMLA cream and amethocaine gel in pediatric patients are warranted. IMPACT Procedural pain is a major concern for pediatric patients, their families, and physicians. Topical anesthesia is routinely given prior to children undergoing skin-related procedures in the Emergency Department. In pediatric patients, topical anesthetics such as eutectic mixture of local anesthetics cream and amethocaine gel have proved to be pioneering in pain reduction, but the most effective method is often disputed. Presently, this is the most comprehensive pooled analysis of trials comparing EMLA cream and amethocaine gel in pediatric patients undergoing topical anesthesia. Amethocaine performed better with regards to child-reported absence of pain and first attempt cannulation success.
Collapse
Affiliation(s)
| | | | | | | | - Mabel N Abraham
- The Feinstein Institutes for Medical Research, New Hyde Park, NY, USA
| |
Collapse
|
6
|
Wolter NE, Tepsich ME, Daien ES, Levinsky JT, Vanderpost ME, Propst EJ, Siu JM. Oral Sucrose in Infants Undergoing Flexible Nasolaryngoscopy: A Blinded Randomized Pilot Study. Laryngoscope 2024. [PMID: 38415844 DOI: 10.1002/lary.31371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Flexible nasolaryngoscopy (FNL) is a common, uncomfortable procedure performed to assess the upper airway in infants. Oral sucrose is used during various painful procedures in infants but has not been used during FNL. Our objective was to understand the impact of oral sucrose on discomfort in infants undergoing FNL. METHODS Infants (<12-months-old) undergoing FNL in the otolaryngology clinic were randomized to treatment (0.5 mL 24% oral sucrose) or standard management (no sucrose). Sucrose was administered <2 min prior to FNL performed by a single endoscopist. Outcome measures included: EVENDOL pain scale and cry duration and visit duration. Infant discomfort was measured by a second observer who was blinded to treatment group. RESULTS Forty-seven infants were included, 23 were treated with sucrose and 24 with standard management. The median (IQR) age was 3.0 (2-5.7) months. There were no significant differences in age, weight, or sex across groups. The median (IQR) duration of FNL was 35.2 (26.5-58.4) and 36.4 (28.9-51.8) seconds for treatment and standard management groups, respectively. Mean (SD) EVENDOL scores were significantly lower in the sucrose group [4.9 (2.0)] than standard group (6.7 [2.1]) (p = 0.003). Mean cry duration after FNL was significantly shorter in the sucrose group (29.9 [20.4] seconds) than the standard group (52.7.0 [40.6] seconds) (p = 0.02). Median (IQR) visit duration did not differ across groups (1.1 [0.9-1.3] vs. 1.1 [0.7-1.4] h [p = 0.15]). CONCLUSION Oral sucrose given before FNL reduced EVENDOL scores and cry duration after FNL and did not prolong clinic visits in this randomized pilot study. LEVEL OF EVIDENCE 2 Laryngoscope, 2024.
Collapse
Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Meghan E Tepsich
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ellie S Daien
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Justin T Levinsky
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mary-Elizabeth Vanderpost
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Nocera Kelley M, Lynders W, Pelletier E, Petrucelli M, Emerson B, Tiyyagura GK, Goldman MP. Increasing the use of anxiolysis and analgesia for paediatric procedures in a community emergency department network: a quality improvement initiative. Emerg Med J 2024; 41:116-122. [PMID: 38050053 DOI: 10.1136/emermed-2023-213232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/09/2023] [Indexed: 12/06/2023]
Abstract
Prior reports describe the care children receive in community EDs (CEDs) compared with paediatric EDs (PEDs) as uneven. The Emergency Medical Services for Children (EMSC) initiative works to close these gaps using quality improvement (QI) methodology. Project champion from a community hospital network identified the use of safe pharmacological and non-pharmacological anxiolysis and analgesia (A&A) as one such gap and partnered with EMSC to address it. Our primary Specific, Measurable, Achievable, Relevant and Time-Bound (SMART) aim was to increase intranasal midazolam (INM) use for common, anxiety-provoking procedures on children <8 years of age from 2% to 25% in a year.EMSC facilitated a QI team with representation from the CED and regional children's hospitals. Following the model for improvement, we initiated a process analysis of this CED A&A practice. Review of all paediatric procedural data identified common anxiety-provoking simple procedures as laceration repairs, abscess drainage and foreign body removal. Our SMART aims were benchmarked to two regional PEDs and tracked through statistical process control. A balancing metric was ED length of stay (ED LOS) for patients <8 years of age requiring a laceration repair. Additionally, we surveyed CED frontline staff and report perceptions of changes in A&A knowledge, attitudes and practice patterns. These data prioritised and informed our key driver diagram which guided the Plan-Do-Study-Act (PDSA) cycles, including guideline development, staff training and cognitive aids.Anxiety-provoking simple procedures occurred on average 10 times per month in children <8 years of age. Through PDSA cycles, the monthly average INM use increased from 2% to 42%. ED LOS was unchanged, and the perceptions of provider's A&A knowledge, attitudes and practice patterns improved.A CED-initiated QI project increased paediatric A&A use in a CED network. An A&A toolkit outlines our approach and may simplify spread from academic children's hospitals to the community.
Collapse
Affiliation(s)
- Mariann Nocera Kelley
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine/Traumatology, University of Connecticut School of Medicine, Connecticut Children's Hospital, Hartford, Connecticut, USA
- Emergency Medical Services for Children, Connecticut, New Haven, Connecticut, USA
| | - Willliam Lynders
- Emergency Medical Services for Children, Connecticut, New Haven, Connecticut, USA
- Emergency Medicine, Middlesex Health, Middletown, Connecticut, USA
| | - Emily Pelletier
- Emergency Medicine, Middlesex Health, Middletown, Connecticut, USA
| | - Megan Petrucelli
- Emergency Medical Services for Children, Connecticut, New Haven, Connecticut, USA
- Emergency Medicine, Middlesex Health, Middletown, Connecticut, USA
| | - Beth Emerson
- Department of Pediatrics and the Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gunjan K Tiyyagura
- Department of Pediatrics and the Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Paul Goldman
- Emergency Medical Services for Children, Connecticut, New Haven, Connecticut, USA
- Department of Pediatrics and the Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
8
|
Jain R, Hudson S, Osmond MH, Trottier ED, Poonai N, Ali S. Nitrous oxide use in Canadian pediatric emergency departments: a survey of physician's knowledge, attitudes, and practices. CAN J EMERG MED 2024; 26:47-56. [PMID: 37855985 DOI: 10.1007/s43678-023-00602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Nitrous oxide (N2O) is an inhaled analgesic/ anxiolytic gas with evidence supporting its safety and efficacy for distressing procedures in children. Despite this, its use is not consistent across Canadian pediatric emergency departments (EDs). We aimed to characterize a) physicians' knowledge and practices with N2O and b) site-specific N2O protocols in Canadian pediatric EDs to help optimize its use nationally. METHODS This cross-sectional survey was distributed to physician members of Pediatric Emergency Research Canada (PERC) in early 2021. Survey items addressed practice patterns, clinician comfort, and perceived barriers/ facilitators to use. Further, a representative from each ED completed a site-specific inventory of N2O policies and procedures. RESULTS N2O was available in 40.0% of 15 pediatric EDs, with 83.3% of these sites having written policies in place. Of 230 distributed surveys, 67.8% were completed with mean (SD) attending experience of 14.7 (8.6) years and 70.1% having pediatric emergency subspecialty training. Of the 156 respondents, 48.7% used N2O in their clinical practice. The most common indications for use were digit fracture/ dislocation reduction (69.7%), wound closure (60.5%), and incision & drainage (59.2%). Commonly perceived facilitators were N2O equipment availability (73.0% of 156) and previous clinical experience (71.7% of 156). Of the 51.3% of physicians who reported not using N2O, 93.7% did not have availability at their site; importantly, the majority indicated a desire to acquire access. They identified concerns about ventilation/ scavenging systems (71.2% of 80) and unfamiliarity with equipment (52.5% of 80) as the most common barriers to use. CONCLUSIONS Despite evidence to support its use, only half of Canadian pediatric ED physicians surveyed use N2O in their clinical practice for treating procedure-related pain and distress. Increased availability of N2O equipment, protocols, and training may improve clinicians' abilities to better manage pediatric acute pain and distress in the ED.
Collapse
Affiliation(s)
- Rini Jain
- Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
- Faculty of Medicine, Department of Pediatrics, Division of Emergency Medicine, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Summer Hudson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Martin H Osmond
- Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Evelyne D Trottier
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Naveen Poonai
- Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Samina Ali
- Faculty of Medicine and Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| |
Collapse
|
9
|
Martin SR, Hung I, Heyming TW, Fortier MA, Kain ZN. Predictors of parental anxiety in a paediatric emergency department. Emerg Med J 2023; 40:715-720. [PMID: 37591685 DOI: 10.1136/emermed-2022-212917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 08/05/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Children experience significant anxiety in the paediatric ED. Although research from preoperative and primary care samples indicates that parents experience anxiety surrounding their children's medical procedures, less is known about parental anxiety and factors that contribute to higher parental anxiety in the ED. This study aimed to assess parental anxiety in families presenting to a paediatric ED with a variety of presenting concerns and examine demographic and psychological factors associated with parental anxiety. METHODS This cross-sectional study included parents of children <18 years old presenting to a paediatric ED in Orange County, California, USA, for a non-psychiatric complaint between 20 January 2021 and 26 March 2021. Parents were, on average, 34.76±9.10 years old, 87.5% were mothers, 59.2% identified as non-Latinx and parents reported average levels of mental health (T-score=51.21±9.84). Parent state anxiety was assessed via the State-Trait Anxiety Inventory and validated instruments were used to measure child temperament (ie, emotionality, activity, sociability, shyness), previous medical anxiety, and parent physical and mental health. Data were analysed using multiple linear regression models. RESULTS Out of 201 families screened, 150 were eligible, and 120 enrolled. In the sample, 42.5% of parents endorsed clinically significant levels of anxiety in the ED. Regression analyses indicated that lower child activity temperament (ie, tendency to be less active/energetic; B=-3.20, 95% CI -5.70 to -0.70, p=0.012) and poorer parent mental health (B=-0.31, 95% CI -0.52 to -0.09, p=0.006) were independently associated with higher parent anxiety (F(5, 99)=6.77, p=0.004). CONCLUSION Over 40% of parents sampled endorsed clinically significant anxiety in the paediatric ED. Child temperament, specifically lower activity temperament, and poorer parental mental health were identified as contributors to parent anxiety, whereas clinical condition or severity did not influence parent anxiety. Current results may help identify families in need of additional intervention and may improve patient outcomes.
Collapse
Affiliation(s)
- Sarah R Martin
- Anesthesiology & Perioperative Care, University of California Irvine, Irvine, California, USA
- Center on Stress & Health, University of California, Irvine, Orange, California, USA
- Emergency Medicine, Children's Hospital of Orange County, Orange, California, USA
| | - Isaac Hung
- Center on Stress & Health, University of California, Irvine, Orange, California, USA
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Theodore W Heyming
- Emergency Medicine, Children's Hospital of Orange County, Orange, California, USA
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
| | - Michelle A Fortier
- Center on Stress & Health, University of California, Irvine, Orange, California, USA
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Children's Hospital of Orange County, Orange, California, USA
| | - Zeev N Kain
- Anesthesiology & Perioperative Care, University of California Irvine, Irvine, California, USA
- Center on Stress & Health, University of California, Irvine, Orange, California, USA
- Children's Hospital of Orange County, Orange, California, USA
- Child Study Center, Yale University, New Haven, Connecticut, USA
| |
Collapse
|
10
|
Rybojad B, Sieniawski D, Aftyka A. Comparison of Professionally and Parentally Administered Analgesia Before Emergency Department Admission. Pain Manag Nurs 2023; 24:486-491. [PMID: 37244774 DOI: 10.1016/j.pmn.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Pediatric patients frequently present to emergency departments in pain. AIM A cross-sectional prospective study was conducted to investigate the prevalence of acute pain in children attending the ED and arriving by ambulance, as well as the initial ED management of pain. We describe pediatric pain management practices in the pediatric ED, as well as parental pain relief. METHOD Demographic data, medications, and type of transport to hospital were noted. Pain was assessed upon admission and 30 minutes after administration of analgesia. To standardize pain evaluations, only children aged 4 years or older were included in the study. A numeric rating scale was used to assess pain intensity. RESULTS The study group consisted of 124 patients. More than 80% of the patients suffered from trauma, injuries to the extremities were the most common cause of admission, and the patient population showed male predominance (62.1%). Over half of the patients (64.51%) were transported by ambulance. Analgesia was administered in 63.5% of the ambulance cases in contrast to only 13.3% of children brought by their parents. Treatment was significantly related to severity of pain. CONCLUSIONS Both medical emergency teams and parents administered prehospital analgesia insufficiently and without previous assessment. However, medical emergency teams used medications more often than parents. Analgesic therapy used in the emergency department resulted in significant pain reduction.
Collapse
Affiliation(s)
- Beata Rybojad
- Clinic of Pediatric Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland; Department of Emergency Medicine Unit, Medical University of Lublin, Lublin, Poland.
| | - Daniel Sieniawski
- Clinic of Pediatric Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Anna Aftyka
- Department of Anaesthesiological and Intensive Care Nursing, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
11
|
Hudson S, Nishat F, Stinson J, Litwin S, Zeller F, Wiles B, Foster ME, Ali S. Perspectives of Healthcare Providers to Inform the Design of an AI-Enhanced Social Robot in the Pediatric Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1511. [PMID: 37761472 PMCID: PMC10529269 DOI: 10.3390/children10091511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Children commonly experience pain and distress in healthcare settings related to medical procedures such as blood tests and intravenous insertions (IVIs). Inadequately addressed pain and distress can result in both short- and long-term negative consequences. The use of socially assistive robotics (SARs) to reduce procedure-related distress and pain in children's healthcare settings has shown promise; however, the current options lack autonomous adaptability. This study presents a descriptive qualitative needs assessment of healthcare providers (HCPs) in two Canadian pediatric emergency departments (ED) to inform the design an artificial intelligence (AI)-enhanced social robot to be used as a distraction tool in the ED to facilitate IVIs. Semi-structured virtual individual and focus group interviews were conducted with eleven HCPs. Four main themes were identified: (1) common challenges during IVIs (i.e., child distress and resource limitations), (2) available tools for pain and distress management during IVIs (i.e., pharmacological and non-pharmacological), (3) response to SAR appearance and functionality (i.e., personalized emotional support, adaptive distraction based on child's preferences, and positive reinforcement), and (4) anticipated benefits and challenges of SAR in the ED (i.e., ensuring developmentally appropriate interactions and space limitations). HCPs perceive AI-enhanced social robots as a promising tool for distraction during IVIs in the ED.
Collapse
Affiliation(s)
- Summer Hudson
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.H.); (S.A.)
| | - Fareha Nishat
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (F.N.); (B.W.)
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (F.N.); (B.W.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Sasha Litwin
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada;
| | - Frauke Zeller
- School of Computing, Engineering, and The Built Environment, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
| | - Brittany Wiles
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (F.N.); (B.W.)
| | - Mary Ellen Foster
- School of Computing Science, University of Glasgow, Glasgow G12 8RZ, UK;
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.H.); (S.A.)
| |
Collapse
|
12
|
Schultz ML, Melby A, Gray R, Evans FM, Benett S, Niescierenko ML. Pediatric procedural sedation in African clinical settings: A mixed methods study of African providers' sedation practices. Afr J Emerg Med 2023; 13:204-209. [PMID: 37692456 PMCID: PMC10491935 DOI: 10.1016/j.afjem.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/12/2023] [Accepted: 06/25/2023] [Indexed: 09/12/2023] Open
Abstract
Background Little is known about the practice of pediatric procedural sedation in Africa, despite being incredibly useful to the emergency care of children. This study describes the clinical experiences of African medical providers who use pediatric procedural sedation, including clinical indications, medications, adverse events, training, clinical guideline use, and comfort level. The goals of this study are to describe pediatric sedation practices in resource-limited settings in Africa and identify potential barriers to the provision of safe pediatric sedation. Methods This mixed methods study describes the pediatric procedural sedation practices of African providers using semi-structured interviews. Purposive sampling was used to identify key informants working in African resource-limited settings across a broad geographic, economic, and professional range. Quantitative data about provider background and sedation practices were collected concurrently with qualitative data about perceived barriers to pediatric procedural sedation and suggestions to improve the practice of pediatric sedation in their settings. All interviews were transcribed, coded, and analyzed for major themes. Results Thirty-eight key informants participated, representing 19 countries and the specialties of Anesthesia, Surgery, Pediatrics, Critical Care, Emergency Medicine, and General Practice. The most common indication for pediatric sedation was imaging (42%), the most common medication used was ketamine (92%), and hypoxia was the most common adverse event (61%). Despite 92% of key informants stating that pediatric procedural sedation was critical to their practice, only half reported feeling adequately trained. The three major qualitative themes regarding barriers to safe pediatric sedation in their settings were: lack of resources, lack of education, and lack of standardization across sites and providers. Conclusions The results of this study suggest that training specialized pediatric sedation teams, creating portable "pediatric sedation kits," and producing locally relevant pediatric sedation guidelines may help reduce current barriers to the provision of safe pediatric sedation in resource-limited African settings.
Collapse
Affiliation(s)
- Megan L. Schultz
- Department of Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew Melby
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebecca Gray
- Department of Anaesthesia and Peri-Operative Medicine, Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Faye M. Evans
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Benett
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle L. Niescierenko
- Department of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Ceylan M, Erkut Z. The effect of finger puppet on pain and emotional manifestation for venous blood collection in the pediatric emergency department: A randomized controlled trial. Int Emerg Nurs 2023; 70:101348. [PMID: 37708789 DOI: 10.1016/j.ienj.2023.101348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
AIM To determine the effect of distraction with a finger puppet for venous blood collection in the pediatric emergency department on children's pain and emotional manifestation. METHODS Randomized controlled trial with 80 children (aged 3-6 years) who applied to the pediatric emergency department between October 2021 and March 2022. The attention of child was distracted from the procedure by playing with finger puppets before and during the venous blood collection in the finger puppet group. The children in the control group underwent routine blood collection. The procedural pain was measured with the Face, Legs, Activity, Cry, Consolability Scale (FLACC) and the emotional response was measured with the Children's Emotional Manifestation Scale (CEMS). RESULTS The mean FLACC pain scores of the children in the finger puppet group were statistically significantly lower than the children in the control group (p < 0.001). It was also found that the finger puppet group's mean scores of CEMS before and during the procedure were statistically lower than those of the control group (p < 0.001). CONCLUSIONS Finger puppets can be used to reduce pain and positively change children's emotional responses during painful procedures such as blood collection.
Collapse
Affiliation(s)
- Murat Ceylan
- Pediatric Emergency Department, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Turkey.
| | - Zeynep Erkut
- Department of Pediatric Nursing, School of Nursing, Maltepe University, Istanbul, Turkey.
| |
Collapse
|
14
|
Nishat F, Hudson S, Panesar P, Ali S, Litwin S, Zeller F, Candelaria P, Foster ME, Stinson J. Exploring the needs of children and caregivers to inform design of an artificial intelligence-enhanced social robot in the pediatric emergency department. J Clin Transl Sci 2023; 7:e191. [PMID: 37745926 PMCID: PMC10514688 DOI: 10.1017/cts.2023.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/30/2023] [Accepted: 07/30/2023] [Indexed: 09/26/2023] Open
Abstract
Background & Objective Socially assistive robots (SARs) are a promising tool to manage children's pain and distress related to medical procedures, but current options lack autonomous adaptability. The aim of this study was to understand children's and caregivers' perceptions surrounding the use of an artificial intelligence (AI)-enhanced SAR to provide personalized procedural support to children during intravenous insertion (IVI) to inform the design of such a system following a user-centric approach. Methods This study presents a descriptive qualitative needs assessment of children and caregivers. Data were collected via semi-structured individual interviews and focus groups. Participants were recruited from two Canadian pediatric emergency departments (EDs) between April 2021 and January 2022. Results Eleven caregivers and 19 children completed 27 individual interviews and one focus group. Three main themes were identified: A. Experience in the clinical setting, B. Acceptance of and concerns surrounding SARs, and C. Features that support child engagement with SARs. Most participants expressed comfort with robot technology, however, concerns were raised about sharing personal information, photographing/videotaping, and the possibility of technical failure. Suggestions for feature enhancements included increasing movement to engage a child's attention and tailoring language to developmental age. To enhance the overall ED experience, participants also identified a role for the SAR in the waiting room. Conclusion Artificial intelligence-enhanced SARs were perceived by children and caregivers as a promising tool for distraction during IVIs and to enhance the overall ED experience. Insights collected will be used to inform the design of an AI-enhanced SAR.
Collapse
Affiliation(s)
- Fareha Nishat
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Summer Hudson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Prabdeep Panesar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sasha Litwin
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Frauke Zeller
- School of Computing, Engineering, and The Built Environment, Edinburgh Napier University, Edinburgh, SC, UK
| | - Patricia Candelaria
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Delgado-Miguel C, Miguel-Ferrero M, Ezquerra A, Díaz M, De Ceano-Vivas M, López-Gutiérrez JC. Sedoanalgesia in the Debridement of Pediatric Burns in the Emergency Department: Is It Effective and Safe? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1137. [PMID: 37508633 PMCID: PMC10378088 DOI: 10.3390/children10071137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The routine use of sedoanalgesia has increased the number of potential minor surgical procedures that can be performed in the Emergency Department (ED) without requiring general anesthesia and, thus, hospital admission. Our aim is to analyze the effectiveness and safety of the use of sedoanalgesia in childhood burns treated in the ED. METHODS A retrospective study was conducted in burned children in whom burn debridement was performed under sedoanalgesia in the ED between 2017 and 2021 in a tertiary referral center for burns. We collected demographic variables, burn features and the type of sedoanalgesia performed in each case, including its effectiveness and associated adverse effects. RESULTS A total of 227 patients (118 males, 109 females) were included, with a median age of 25 months. In total, 99.2% of the burns were thermal (69.2% scald burns), with a mean total body surface area (TBSA) burned of 4%. The most commonly used drugs were intravenous ketamine (35.7%), intravenous ketamine + midazolam (15.4%), intranasal fentanyl + midazolam (14.1%) and intranasal fentanyl (10.6%). The effectiveness of sedoanalgesia was considered satisfactory in 95.2% of the cases, with an adverse effect rate of 7.5%, without severe adverse effects reported. CONCLUSIONS The use of sedoanalgesia in the ED in the early treatment of childhood burns achieves high effectiveness and safety. It is postulated as a quality indicator; thus, it should be known by all pediatric healthcare practitioners.
Collapse
Affiliation(s)
- Carlos Delgado-Miguel
- Pediatric Burn Unit, Department of Pediatric Surgery, La Paz Children's Hospital, 28046 Madrid, Spain
- Institute for Health Research IdiPAZ, La Paz University Hospital, 28046 Madrid, Spain
| | - Miriam Miguel-Ferrero
- Pediatric Burn Unit, Department of Pediatric Surgery, La Paz Children's Hospital, 28046 Madrid, Spain
| | - Andrea Ezquerra
- Department of Pediatric Emergency, La Paz Children's Hospital, 28046 Madrid, Spain
| | - Mercedes Díaz
- Pediatric Burn Unit, Department of Pediatric Surgery, La Paz Children's Hospital, 28046 Madrid, Spain
| | - María De Ceano-Vivas
- Department of Pediatric Emergency, La Paz Children's Hospital, 28046 Madrid, Spain
| | | |
Collapse
|
16
|
V R P, A VS, Ramar K. Changing Trends in Conscious Sedation at Pediatric Dental Offices: A Bibliometric Analysis. Cureus 2023; 15:e40191. [PMID: 37431365 PMCID: PMC10329863 DOI: 10.7759/cureus.40191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
The uncooperative behavior of children in the dental office has increased the demand for pharmacological behavior management techniques. Moderate sedation is more effective by providing analgesia and anxiolysis, thereby aiding in carrying out the most comfortable, efficient, and high-quality dental services. There is a need to understand the various aspects such as the choice of drug, method of drug administration, safety, and efficacy. Bibliometrics can reveal significant shifts in research and publication trends. Therefore, this study aimed to perform a bibliometric analysis of the literature on evolving trends in conscious sedation at pediatric dental offices. The bibliometric research used RStudio 2021.09.0+351 for Windows (RStudio, Boston, MA), package "bibliometrix," and VOS viewer software (Centre for Science and Technology Studies, Leiden University, The Netherlands. https://www.vosviewer.com). Elsevier's Scopus database (www.scopus.com) provided the literary data for this study, which were exported in BibTex format. The articles were independently categorized according to the following aspects: (a) annual scholarly output; (b) leading countries or regions; (c) leading journals; (d) productive authors; (e) citations; (f) study design; and (g) distribution of topics. The findings considered 1996 through 2022 and used journals, books, articles, and other sources, totaling 1064 papers, with an average of 10.7 per year. According to the findings, the United States, the United Kingdom, and India were principally leading the field of conscious sedation research. In total, 2433 authors were found through the search. The study identified the nations that are currently researching the topics such as midazolam and nitrous-oxide; this paves the way for future partnerships to strengthen the evidence generated in other topic areas using novel sedatives and exploring the different routes of drug administration, thereby benefiting the scientific community by identifying knowledge gaps and experts in this area of research.
Collapse
Affiliation(s)
- Pooja V R
- Department of Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College and Hospital, Kattankulathur, IND
| | - Victor Samuel A
- Department of Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College and Hospital, Kattankulathur, IND
| | - Kavitha Ramar
- Department of Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College and Hospital, Kattankulathur, IND
| |
Collapse
|
17
|
Poonai N, Cohen DM, MacDowell D, Mistry RD, Mintegi S, Craig S, Roland D, Miller M, Shavit I. Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception. JAMA Netw Open 2023; 6:e2317200. [PMID: 37285152 PMCID: PMC10248743 DOI: 10.1001/jamanetworkopen.2023.17200] [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] [Received: 02/21/2023] [Accepted: 04/24/2023] [Indexed: 06/08/2023] Open
Abstract
Importance Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists. Objective To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction. Design, Setting, and Participants This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022. Exposures Reduction of ileocolic intussusception. Main outcomes and measures The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception. Results We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P < .001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P = .002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P = .002) remained significant. Conclusions and Relevance This cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.
Collapse
Affiliation(s)
- Naveen Poonai
- Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Daniel M. Cohen
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Doug MacDowell
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Rakesh D. Mistry
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces University of the Basque Country, UPV/EHU. Bilbao, Basque Country, Spain
| | - Simon Craig
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, Leicester University, Leicester, United Kingdom
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children’s Emergency Department, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Michael Miller
- Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Itai Shavit
- Department of Paediatrics, Hadassah Hebrew University Hospitals, Jerusalem, Israel
| | | |
Collapse
|
18
|
Kassam-Adams N, Butler L, Price J, Gawel M, Graham L, Myers S, Auerbach M. Trauma-informed and family-centered paediatric resuscitation: Defining domains and practices. Resusc Plus 2023; 14:100374. [PMID: 37007186 PMCID: PMC10064226 DOI: 10.1016/j.resplu.2023.100374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/28/2023] Open
Abstract
Aim For paediatric patients and families, resuscitation can be an extremely stressful experience with significant medical and psychological consequences. Psychological sequelae may be reduced when healthcare teams apply patient- and family-centered care and trauma-informed care, yet there are few specific instructions for effective family-centered or trauma-informed behaviours that are observable and teachable. We aimed to develop a framework and tools to address this gap. Methods We reviewed relevant policy statements, guidelines, and research to define core domains of family-centered and trauma-informed care, and identified observable evidence-based practices in each domain. We refined this list of practices via review of provider/team behaviours in simulated paediatric resuscitation scenarios, then developed and piloted an observational checklist. Results Six domains were identified: (1) Sharing information with patient and family; (2) Promoting family involvement in care and decisions; (3) Addressing family needs and distress; (4) Addressing child distress; (5) Promoting effective emotional support for child; (6) Practicing developmental and cultural competence. A 71-item observational checklist assessing these domains was feasible for use during video review of paediatric resuscitation. Conclusion This framework can guide future research and provide tools for training and implementation efforts to improve patient outcomes through patient- and family-centered and trauma-informed care.
Collapse
Affiliation(s)
- Nancy Kassam-Adams
- Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Lucas Butler
- Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Julia Price
- Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE 19803, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19107, USA
| | - Marcie Gawel
- Yale New Haven Hospital, 20 York St, New Haven, CT 06510, USA
| | - Leila Graham
- Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Sage Myers
- Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Marc Auerbach
- Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
- Yale New Haven Children’s Hospital, 35 Park St, New Haven, CT 06511, USA
| |
Collapse
|
19
|
Poonai N, Creene C, Dobrowlanski A, Geda R, Hartling L, Ali S, Bhatt M, Trottier ED, Sabhaney V, O'Hearn K, Jain R, Osmond MH. Inhaled nitrous oxide for painful procedures in children and youth: a systematic review and meta-analysis. CAN J EMERG MED 2023:10.1007/s43678-023-00507-0. [PMID: 37171705 DOI: 10.1007/s43678-023-00507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/02/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The objective of this study was to synthesize indication-based evidence for N2O for distress and pain in children. STUDY DESIGN We included trials of N2O in participants 0-21 years, reporting distress or pain for emergency department procedures. The primary outcome was procedural distress. Where meta-analysis was not possible, we used Tricco et al.'s classification of "neutral" (p ≥ 0.05), "favorable," or "unfavorable" (p < 0.05, supporting N2O or comparator, respectively). We used the Cochrane Collaboration's Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system to evaluate risk of bias and quality of evidence, respectively. RESULTS We included 30 trials. For pain using the Visual Analog Scale (0-100 mm) during IV insertion, 70% N2O (delta:-16.5; 95%CI:-28.6 to -4.4; p = 0.008; three trials; I2 = 0%) and 50% N2O plus eutectic mixture of local anesthetics (EMLA) (delta:-1.2; 95%CI:-2.1 to -0.3; p = 0.007; two trials; I2 = 43%) were superior to EMLA. 50% N2O was not superior to EMLA (delta:-0.4; 95%CI:-1.2 to 0.3; p = 0.26; two trials; I2 = 15%). For distress and pain during laceration repair, N2O was "favorable" versus each of SC lidocaine, oxygen, and oral midazolam but "neutral" versus IV ketamine (five trials). For distress and pain during fracture reduction (three trials), N2O was "neutral" versus each of IM meperidine plus promethazine, regional anesthesia, and IV ketamine plus midazolam. For distress and pain during lumbar puncture (one trial), N2O was "favorable" versus oxygen. For distress and pain during urethral catheterization (one trial), N2O was "neutral" versus oral midazolam. For pain during intramuscular injection (one trial), N2O plus EMLA was "favorable" versus N2O and EMLA alone. Common adverse effects of N2O included nausea (4.4%), agitation (3.7%), and vomiting (3.6%) AEs were less frequent with N2O alone (278/1147 (24.2%)) versus N2O plus midazolam (48/52 (92.3%)) and N2O plus fentanyl (123/201 (61.2%)). CONCLUSIONS There is sufficient evidence to recommend N2O plus topical anesthetic for IV insertion and laceration repair. Adverse effects are greater when combined with other sedating agents.
Collapse
Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, ON, Canada.
- Division of Emergency Medicine, Western University, London, ON, Canada.
- Children's Health Research Institute, London Health Sciences Centre, London, ON, Canada.
- Division of Pediatric Emergency Medicine, Children's Hospital, London Health Sciences Centre, London, ON, Canada.
| | | | | | - Rishika Geda
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Maala Bhatt
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Evelyne D Trottier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Vikram Sabhaney
- BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Katie O'Hearn
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rini Jain
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Martin H Osmond
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
20
|
Hwang S, Lee JH, Kwak YH, Kim DK, Jung JH, Jung JY, Kwon H, Suh D, Choi YJ, Lee SU, Park JW. Predictors of Caregiver Satisfaction With Pediatric Laceration Repair in the Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:324-328. [PMID: 37115990 DOI: 10.1097/pec.0000000000002604] [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
OBJECTIVES The objective of this study was to define the care factors that are important to caregivers' satisfaction with pediatric laceration repair and the overall emergency department (ED) experience. METHODS This was a cross-sectional observation study performed in an urban tertiary hospital. The caregivers of patients younger than 18 years who presented to the ED for laceration repair completed a survey. Demographic data were analyzed. Univariate and multivariate logistic regressions were used to determine the factors related to satisfaction with the laceration repair and the overall ED experience. RESULTS Fifty-five caregivers were enrolled. Most of the children had facial lacerations (n = 44, 80%). The median length of ED stay was 181 minutes (interquartile range [IQR], 157-208 minutes). The children's median age was 41.8 months (IQR, 23-91 months); the caregivers' median age was 37 years (IQR, 35-41 years). Most lacerations were repaired by plastic surgeons (81.8%). In the multivariate regression analysis, preparation before the procedure, mid-income family, caring attitude of the nurse, cosmetic outcome, and measures to control the patient's anxiety were significantly related to the caregiver's satisfaction with laceration repair (P < 0.05), whereas preparation before the procedure and ED environment were significantly related to the caregiver's satisfaction with the overall ED experience (P < 0.05). CONCLUSIONS Preparation before the procedure was significantly related to the caregiver's satisfaction with both pediatric laceration repair and the overall PED experience. The strongest predictors were cosmetic outcome for laceration repair and preparation for the procedure for the overall PED experience. Our findings suggest that improvements in various aspects will increase parent satisfaction.
Collapse
Affiliation(s)
- Soyun Hwang
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | | | - Young Ho Kwak
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Do Kyun Kim
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Jin Hee Jung
- Department of Emergency Medicines, SMG-SNU Boramae Medical Center, Seoul
| | - Jae Yun Jung
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Gyeonggi
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Joong Wan Park
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
| |
Collapse
|
21
|
Gao F, Wu Y. Procedural sedation in pediatric dentistry: a narrative review. Front Med (Lausanne) 2023; 10:1186823. [PMID: 37181379 PMCID: PMC10169594 DOI: 10.3389/fmed.2023.1186823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Procedural sedation and analgesia are now considered standard care for managing pain and anxiety in pediatric dental patients undergoing diagnostic and therapeutic procedures outside of the operating room. Anxiolysis, which combines both pharmacologic and non-pharmacologic approaches, plays a significant role in procedural sedation. Non-pharmacologic interventions such as Behavior Management Technology can help reduce preprocedural agitation, ease the transition to sedation, reduce the required amount of medication for effective sedation, and decrease the occurrence of adverse events. As the introduction of novel sedative regimen and methods in pediatric dentistry, the potential role of mainstay sedatives administered by new routes, for new indications, and with new delivery techniques, should be considered. The purpose of this paper is to examine and discuss the current state of sedation techniques in pediatric dentistry.
Collapse
Affiliation(s)
- Feng Gao
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Laboratory of Oral Diseases and Biomediacal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yujia Wu
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Laboratory of Oral Diseases and Biomediacal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| |
Collapse
|
22
|
Slim G, van Manen M, Fowler M, Poonai N, Ali S. What influences physician opioid prescribing for children with acute pain? Br J Pain 2023; 17:195-205. [PMID: 37057252 PMCID: PMC10088422 DOI: 10.1177/20494637221146421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Pain is one of the most common symptoms encountered in the healthcare system, and opioids are among the top three medications used to treat it. Understanding the reasoning behind physicians' opioid prescribing practices is vital to safe practice. The primary objective of our study was to describe pediatric emergency physicians' decision-making process when prescribing opioids for children's acute pain management. Methods This study employed qualitative methodology, using one-on-one semi-structured interviews within a grounded theory analytic framework. We employed purposeful sampling to recruit pediatric emergency physicians from across Canada. Interviews were conducted by telephone (December 2019-January 2021). Transcript analysis occurred concurrently with data collection, supporting data saturation and theory development considerations. Results Eleven interviews were completed with participants representing each of Canada's geographic regions. Nine major themes emerged: (1) practice setting and outpatient opioid use, (2) condition-specific considerations, (3) physician confidence in medical evidence, (4) pain assessment challenges, (5) patient and family perspectives, (6) opioid safety concerns, (7) personal biases and experiences, (8) personal practice context, and (9) the Opioid Crisis/media influence. Most clinicians felt that they limited opioid use to those who needed it most; all participants described challenges managing acute pain, emphasizing the need for accurate pain measurement and better guidelines, evidence-based data, and knowledge translation. Clinicians were more comfortable treating pain in the emergency department, compared to discharge prescribing. They recognized the importance of co-therapy with non-opioids and the need for opioid risk assessment when prescribing. A family centered approach was recognized as the goal of practice. Conclusion Clinicians are less comfortable prescribing opioids to children for at-home use and find pain assessment and lack of clear guidelines to be barriers to pain care. Knowledge translation strategies for safer practice and optimal acute pain management could support responsible and judicious opioid use.
Collapse
Affiliation(s)
- George Slim
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Michael van Manen
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Megan Fowler
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Naveen Poonai
- Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children Health Research Institute, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
23
|
Kim JS. Children's experiences of intravenous injection using the draw, write, and tell method: A mixed-methods study. J Pediatr Nurs 2023; 71:14-22. [PMID: 36958135 DOI: 10.1016/j.pedn.2023.03.005] [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: 12/15/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/25/2023]
Abstract
PURPOSES This study aimed to explore children's perceptions and experiences of receiving intravenous (IV) injections and the self-reported pain scores and management strategies that can support children while receiving IV injections. DESIGN AND METHODS This mixed-methods study included 17 children aged 4-11 years who presented to the outpatient clinic of a pediatric hospital and received IV injections. Data were collected using the draw, write, and tell method (DWT) and Facial Pain Rating Scale. Descriptive statistics and content analyses were performed. RESULTS The children's self-reported mean pain score was 4.82, indicating moderate pain. Many expressions indicated that IV injections were painful or caused tingling or stinging sensations. A vague fear of needles in addition to pain was identified after listening to the children and analyzing their own interpretation of drawings. Three main themes were identified: (1) physical and emotional experiences, (2) parents as my secure base, and (3) comfort and relief strategies. CONCLUSIONS Children expressed their experiences during IV injections, the alleviation of their pain and fear, and their suggestions for comfort and relief strategies visually, auditorily, and verbally. Parents played an important role in supporting their children and reducing pain, anxiety, and distress related to the IV procedure. PRACTICE IMPLICATIONS The DWT, as an arts-based and child-centered approach, is a useful and valid method to understand children's experience related to the IV injection. Children experience comfort and relief within a family-centered care context during IV injection. Nurses should promote children's and parents' participation in the development of strategies to reduce the negative effects of IV injections in children.
Collapse
Affiliation(s)
- Jin Sun Kim
- Department of Nursing, Chosun University, South Korea.
| |
Collapse
|
24
|
Gripko M, Joseph A, MohammadiGorji S. Effects of the physical environment on children and families in hospital-based emergency departments: A systematic literature review. JOURNAL OF ENVIRONMENTAL PSYCHOLOGY 2023; 86:101970. [PMID: 37366532 PMCID: PMC10292152 DOI: 10.1016/j.jenvp.2023.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Every year, millions of children seek care in emergency departments (EDs) for various conditions. Though the physical environment of the ED provides the context and setting for care delivery, influences workflows, and shapes interactions between users, the noisy, sterile, stimulating nature of the ED can be counter-therapeutic to pediatric patients and families. This systematic literature review investigates this complex dynamic and asks how the physical environment of emergency departments affects children and their families or guardians. Using PRISMA methods, this review searched four databases to identify and analyze twenty-one peer-reviewed articles that explored the impacts of the physical environment of hospital-based EDs on children or family members. Several themes emerged from the literature - concerning control, positive distractions, family and social supports, and designing for a safe and comfortable experience - that illustrate opportunities for future ED design and highlight knowledge gaps and avenues for future research.
Collapse
Affiliation(s)
- Monica Gripko
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, United States
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, United States
| | | |
Collapse
|
25
|
Rached-d'Astous S, Finkelstein Y, Bailey B, Marquis C, Lebel D, Desjardins MP, Trottier ED. Intranasal ketamine for procedural sedation in children: An open-label multicenter clinical trial. Am J Emerg Med 2023; 67:10-16. [PMID: 36774905 DOI: 10.1016/j.ajem.2023.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION There are limited options for pain and distress management in children undergoing minor procedures, without the burden of an intravenous line insertion. Prior to this study, we conducted a dose-escalation study and identified 6 mg/kg as a potentially optimal initial dose of intranasal ketamine. OBJECTIVE To assess the efficacy and safety of intranasal ketamine at a dose of 6 mg/kg for procedural sedation to repair lacerations with sutures in children in the emergency department. METHODS We conducted a single-arm, open-label multicenter clinical trial for intranasal ketamine for laceration repair with sutures in children aged 1 to 12 years. A convenience sample of 30 patients received 6 mg/kg of intranasal ketamine for their procedural sedation. The primary outcome was the proportion (95% CI) of patients who achieved an effective procedural sedation. RESULTS We recruited 30 patients from April 2018 to December 2019 in two pediatric emergency departments in Canada. Lacerations repaired were mostly facial in 21(70%) patients and longer than 2 cm in 20 (67%) patients. Sedation was effective in 18/30 (60% [95% CI 45, 80]) children and was suboptimal in 5 (17%) patients but procedure was completed in them with minimal difficulties. Sedation was poor in the remaining 7 (23%) patients, with 3 (10%) of them required additional sedative agents. No serious adverse events were reported. CONCLUSIONS Using a single dose of 6 mg/kg of intranasal Ketamine for laceration repair led to successful sedation in 60% of patients according to our a priori definition. An additional 17% of patients were considered suboptimal, but their procedure was still completed with minimal difficulty. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT03053947).
Collapse
Affiliation(s)
- Soha Rached-d'Astous
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
| | - Yaron Finkelstein
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Benoit Bailey
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Christopher Marquis
- Pharmacy department, CHU Sainte Justine, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Denis Lebel
- Pharmacy department, CHU Sainte Justine, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Marie-Pier Desjardins
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Evelyne D Trottier
- Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| |
Collapse
|
26
|
Eimer C, Reifferscheid F, Jung P, Rudolph M, Terboven T, Hoffmann F, Lorenzen U, Köser A, Seewald S. Pre-hospital analgesia in pediatric trauma and critically ill patients: An analysis of a German air rescue service. Scand J Trauma Resusc Emerg Med 2023; 31:5. [PMID: 36709289 PMCID: PMC9883913 DOI: 10.1186/s13049-023-01069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Pain management in the pre-hospital setting remains a particular challenge for paramedics and emergency physicians, especially in children. This study evaluates the pre-hospital use and effect of analgesics in children with trauma or pain due to other reasons. METHODS This study is a retrospective analysis of the database of a German air rescue service and was conducted over a period of 9 years (2012-2020) to assess pain in general and whether patients with trauma pain due to other reasons received treatment with analgesics. We included all patients in the registry under the age of 16 years. Patients with a Glasgow Coma Scale of 3 at hospital admission and incomplete records were excluded. The intensity of pain was determined by the emergency physician on scene at arrival and hospital admission in a ten-point rating scale (0 = no pain). Effective pain reduction was analyzed. RESULTS Out of 227,458 cases, a total of 22,025 emergency cases involved pediatric patients aged 0-16 years. 20,405 cases were included in the study. 12,000 (58.8%) children had suffered a trauma, 8108 (39.7%) had pain due to other reasons and 297 (1.5%) had both. In total, 4,608 (38.4%) of the children with trauma were assessed having a numerical rating scale (NRS) > 4 at EMS arrival. These patients received mainly ketamine (34.5%) and the opioids fentanyl (38.7%) and piritramide (19.1%). The value on the NRS was significantly lower at admission to hospital (mean 1.9) compared with the EMS arrival (mean 6.9). In 4.9% the NRS at hospital admission was still > 4. 282 patients within the non-trauma group had a pre-hospital NRS of > 4. The pain therapy consisted of opioids (35.8%) and ketamine (2.8%). 28.4% patients in the non-trauma group received no pain medication. In 16.0% the NRS at hospital admission was still > 4. CONCLUSIONS German emergency physicians achieved a sufficient pain therapy in pediatric patients with a NRS > 4 after trauma. In case of non-trauma, the pain management by the emergency physicians is restrained and less successful. The most common analgesic medications administered were ketamine and fentanyl, followed by piritramide. TRIAL REGISTRATION The study has been retrospectively registered at DRKS (DRKS00026222).
Collapse
Affiliation(s)
- Christine Eimer
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany
| | - Florian Reifferscheid
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany ,Department of Pediatrics, German Air Rescue Service Association “DRF Luftrettung”, Filderstadt, Germany
| | - Philipp Jung
- grid.412468.d0000 0004 0646 2097University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Rudolph
- Department of Pediatrics, German Air Rescue Service Association “DRF Luftrettung”, Filderstadt, Germany ,grid.411778.c0000 0001 2162 1728Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Tom Terboven
- grid.492141.bDepartment of Anaesthesiology and Critical Care Medicine, St. Josefskrankenhaus, Heidelberg, Germany
| | - Florian Hoffmann
- grid.411095.80000 0004 0477 2585Dr. Von Hauner University Children’s Hospital, Munich, Germany
| | - Ulf Lorenzen
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany
| | - Andrea Köser
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany
| | - Stephan Seewald
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany ,grid.412468.d0000 0004 0646 2097Department of Emergency Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
27
|
Escobar-Castellanos M, Míguez-Navarro MC, García-Mancebo J, Fernández-Monteagudo B, Pascual-García P, Guerrero-Márquez G, Rivas-García A. How Much Do Parents Know About Pain in Their Children? Pediatr Emerg Care 2023; 39:40-44. [PMID: 36580891 DOI: 10.1097/pec.0000000000002585] [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: 01/03/2023]
Abstract
OBJECTIVES Adequate pain control is essential to the comprehensive management of pediatric patients within the emergency department.The aim of this study is to evaluate parents' knowledge about pain in the pediatric population patient and secondarily describe erroneous concepts that can affect a correct children's pain management. METHODS A single-center descriptive study of cross-sectional surveys was performed between October and December 2018, with a previously validated ad hoc and anonymous questionnaire consisting of 9 items. All parents/guardians participating in the study had a child aged 0 to 18 years who had been admitted to the emergency department. RESULTS Sixty-nine percent (n = 315) were women, 49.9% (n = 226) had university degrees and only 11% (n = 50) had professions related to the healthcare system. A linear association was observed between the number of correct answers and the level of education (β = 1.04; 95% confidence interval, 0.76-1.32; P < 0.001), as well as between parents with professions related to the healthcare system compared with other professions (61.4% vs 51.2% with P = 0.005). The responses of Spanish parents offered better results than answers obtained from parents from the American continent (56.4% vs 41.4% with P < 0.001). No differences were observed between parents of children with chronic diseases. CONCLUSIONS In our study, we observed that a considerable percentage of parents hold misconceptions about how children express pain, and therefore, it would be necessary to encourage formation programs for parents to help identify, evaluate, and correctly treat pain in their children.
Collapse
|
28
|
Effectiveness of Procedural Sedation and Analgesia in Pediatric Emergencies. A Cross-Sectional Study. J Emerg Nurs 2023; 49:75-85. [PMID: 36376128 DOI: 10.1016/j.jen.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Pain is defined as an unpleasant emotional and sensory experience associated with bodily harm or with situations that cause fear and anxiety. However, it is often undertreated in pediatric emergency departments. This study aims to assess the effectiveness of sedation-analgesia techniques, level of satisfaction among health care professionals and relatives, and agreement between the satisfaction of health care professionals and relatives. METHODS A cross-sectional design was conducted. Sociodemographic and clinical variables were recorded, together with those for effectiveness using the Face, Legs, Activity, Cry, and Consolability scale and the Wong-Baker FACES scale, and the satisfaction using the 10-point Likert scale. Stata 16.1 was used for data analysis. RESULTS A total of 94 procedures were registered. The results suggested that these techniques were effective or mildly effective in only half of the cases. Satisfaction was considered good across the board, and the agreement between health care professionals (ie, pediatric nurses and pediatricians) was considered substantial. However, the agreement between health care professionals and relatives was moderate. DISCUSSION Our results suggested that the adequate management of pain in pediatric emergency departments is still a challenge, despite the availability of international guidelines. Future research lines should be focused on analyzing possible causes of the inefficacy of some sedation-analgesia techniques and the causes of the differences between the perspectives of health care professionals and relatives. These research lines may be useful to improve quality of care and pediatric patient comfort.
Collapse
|
29
|
Sánchez-Malo MJ, Llorens-Córcoles AM, Marcote-Martínez BF, Alonso-Salas MT, Míguez-Navarro MC. Recommendations for non-anaesthesia providers in sedation and analgesia procedures. An Pediatr (Barc) 2022; 97:422.e1-422.e10. [PMID: 36347802 DOI: 10.1016/j.anpede.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/24/2022] [Indexed: 11/08/2022] Open
Abstract
Pain and the anxiety that it produces are the main sources of suffering in children managed in emergency departments, eliciting a growing interest in parents and health care providers in the adequate provision of sedation and analgesia. In consequence, the number of diagnostic and therapeutic procedures that require sedation and/or analgesia in paediatric emergency departments has increased in recent years, which has generated a need to train non-anaesthesiologists on how to provide this care without affecting patient safety. The objective of this document is to establish evidence-based recommendations, developed by consensus by the Working Group on Sedation and Analgesia of the Sociedad Española de Urgencias de Pediatría, regarding the competencies and training of staff who perform sedation or analgesia procedures to achieve the greatest possible quality in the management of paediatric patients before, during and after these procedures in the paediatric emergency care setting. The consensus document has been structured in two parts: the first addresses the competencies of non-anaesthesiologists who perform sedoanalgesia procedures, and the second how to obtain the necessary training. A list of research questions was prepared, keywords defined and a literature search carried out to break down and summarise the available evidence. The results are presented in the form of conclusions, which were subjected to anonymous voting by each of the members of the working group. For each of the conclusions, we provide the percent agreement obtained in the voting.
Collapse
|
30
|
Recomendaciones para profesionales no anestesiólogos en procedimientos de sedoanalgesia. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.09.015] [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] Open
|
31
|
Gagnon F, Gravel J, Duranceau C, Vallieres E, Bhatt M, Harman S, Trottier ED. XyloFUNS: Xylocaine to freeze during unpleasant nasopharyngeal swabs in children-a randomized controlled trial. Paediatr Child Health 2022; 27:469-475. [PMID: 36575662 PMCID: PMC9620713 DOI: 10.1093/pch/pxac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/22/2022] [Indexed: 12/30/2022] Open
Abstract
Objectives To evaluate the efficacy of intranasal vaporized lidocaine in reducing pain for children undergoing a nasopharyngeal (NP) swab in the Emergency Department (ED). Study Design A randomized blinded clinical trial was conducted in a paediatric ED. Both participants and the researcher evaluating the primary outcome were blinded. Children aged 6 to 17 years old requiring a NP swab were eligible. Participants were randomly allocated to receive intranasal lidocaine or a sham treatment prior to their NP swab. The primary outcome measure was pain during the swab as assessed by the visual analog scale. Secondary outcome measures were pain using the verbal numeric rating scale, fear using the children fear scale, and adverse effects of the intervention. Results Eighty-eight participants were enrolled-45 in the lidocaine group and 43 controls. The mean visual analog scale scores for pain were 46 mm in the lidocaine group and 53 mm in the control group (mean difference 7 mm; 95% CI: -5 to 19 mm). No serious adverse events were observed. Conclusions Intranasal lidocaine administered prior to NP swabs in the ED failed to show an improvement in pain scores for school-aged children and youth.
Collapse
Affiliation(s)
- François Gagnon
- Correspondence: Francois Gagnon, Children’s Hospital of Eastern Ontario (CHEO), 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada. Telephone: 514-412-4400, fax: 514-412-4217, e-mail:
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Camille Duranceau
- Division of Pediatric Emergency Medicine, CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Emilie Vallieres
- Division of Microbiology, Clinical Laboratory Medicine Department, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada,Division of Infectious Diseases, Pediatrics Department, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Maala Bhatt
- Division of Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Stuart Harman
- Division of Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Evelyne D Trottier
- Division of Pediatric Emergency Medicine, CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
32
|
de Vries TW. Low Relevancy of Outcome Measurements of Studies of Pediatric Pain in the Emergency Department. Pediatr Emerg Care 2022; 38:431-435. [PMID: 36040463 PMCID: PMC9426731 DOI: 10.1097/pec.0000000000002799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Many children visiting the emergency department (ED) experience pain. Several pharmacological and nonpharmacological interventions are used for pain control. Little is known about the outcome measurements in studies about pain in children in the ED.Furthermore, it is not known if complete pain relief was reached. METHODS PubMed, the Cochrane Database of Systematic Reviews, and EMBASE were searched for articles on clinical trials for pain relief in children in the ED. Inclusion criteria contained predictable and identifiable pain such as after trauma or during procedures. RESULTS Of 620 articles found, 45 fulfilled the criteria. Twenty studies (44%) used pharmacological interventions, and 25 (56%) studied nonpharmacological interventions. In 24 studies (53%), a statistically significant pain reduction was described in the intervention group. In 21 studies (47%), a clinically relevant reduction in pain was found. In only 1 study, the reported aim was to reach absence of pain. CONCLUSION Half of the interventions decreased pain in children in the ED. However, most studies did not aim at complete pain relief. Even in intervention groups with statistically significant decrease in pain, children still had pain. Children in the ED deserve better.Complete pain relief should be the goal of any intervention for these children in the ED.Studies on pain treatment in the ED should have complete pain relief as primary end point.
Collapse
Affiliation(s)
- Tjalling W de Vries
- From the Department of Pediatrics, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| |
Collapse
|
33
|
Nemetski SM, Berman DI, Khine H, Fein DM. Virtual Reality as Anxiolysis During Laceration Repair in the Pediatric Emergency Department. J Emerg Med 2022; 63:72-82. [PMID: 35934650 DOI: 10.1016/j.jemermed.2022.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although procedural pain is effectively treated with analgesics, managing anxiety during laceration repair is more challenging. OBJECTIVES We examined the feasibility of using immersive virtual reality (VR) as anxiolysis during laceration repair in the pediatric emergency department (ED). METHODS We conducted a non-blinded, observational, pilot study in an urban pediatric ED that enrolled a convenience sample of children aged 5-13 years undergoing sutured repair of non-facial lacerations. Subjects played an immersive VR game while undergoing laceration repair. Parents assessed their child's anxiety on a 100-mm visual analogue scale at enrollment and during laceration repair. The primary outcome measure was the percentage of children whose anxiety score did not increase by ≥ 20 mm from enrollment to the first stitch. RESULTS Forty patients completed the study. Mean initial anxiety score was 54 mm (standard deviation 33 mm). Thirty-seven of forty patients (93%; 95% confidence interval [CI] 83-99%) had anxiety scores that did not increase by 20 mm or more from enrollment to the first stitch. Eighty percent (95% CI 64-91%) of patients' anxiety scores decreased between enrollment and first stitch. The mean change in anxiety score at first stitch was -39 mm (95% CI -51 mm to -27 mm; p < 0.001). Similar downward trends in anxiety scores were noted throughout the procedure. All laceration repairs were successfully completed without sedation or restraints. There were no adverse events noted, and the main barriers identified with VR use involved easily correctable technical difficulties with the equipment. CONCLUSION Immersive VR is a safe and effective distractive technique to reduce procedural anxiety during laceration repair in the pediatric ED.
Collapse
Affiliation(s)
| | - Danielle I Berman
- Department of Pediatrics, Albert Einstein College of Medicine - Children's Hospital at Montefiore, Bronx, New York
| | - Hnin Khine
- Division of Pediatric Emergency Medicine, Department of Pediatrics
| | - Daniel M Fein
- Division of Pediatric Emergency Medicine, Department of Pediatrics
| |
Collapse
|
34
|
Fusetti V, Re L, Pigni A, Tallarita A, Cilluffo S, Caraceni AT, Lusignani M. Clown therapy for procedural pain in children: a systematic review and meta-analysis. Eur J Pediatr 2022; 181:2215-2225. [PMID: 35294645 DOI: 10.1007/s00431-022-04440-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 12/16/2022]
Abstract
UNLABELLED Among the distraction techniques used for the non-pharmacological management of acute pediatric pain, one of the most performed is clown therapy. Despite the presence in the literature of some systematic reviews that evaluate its effectiveness, none of them examines its outcomes on procedural pain which has therefore been investigated in this study. The literature search for randomized controlled trials (RCTs) was performed on the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus over a time frame ranging from each database setup date to 31 July 2021. The primary outcome was the procedural pain of children. We used the Cochrane Risk of Bias tool to assess the risk of bias of the included studies. Six RCTs were selected for this review, which included a total of 517 pediatric subjects. Children undergoing clown therapy during the venipuncture or peripheral vein cannulation procedure reported less pain than those exposed to the standard of care (SMD = -0.55; 95% CI: -1.23, 0.13) but the result was not found to be statistically significant. School-aged children and adolescent reported significantly less pain (SMD = -0.51; 95% CI: -0.92, -0.09). Compared to the standard of care, children's anxiety was significantly lower with clown therapy (SMD = -0.97; 95% CI: -1.38, -0.56). CONCLUSION Clown therapy seems effective in reducing procedural pain in children, particularly for older age groups, but due to poor methodological quality and the high risk of bias of the studies included, the results obtained should be considered with caution. WHAT IS KNOWN • Clown therapy is one of the most used techniques in the non-pharmacological management of acute pediatric pain. • Laughter physiologically stimulates the production of beta-endorphins, substances with an effect similar to opiates. WHAT IS NEW • Clown therapy seems effective in reducing procedural pain and anxiety in children. • The intervention in school-age children or adolescents produces a statistically significant decrease in the symptom.
Collapse
Affiliation(s)
- Viviana Fusetti
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
- Università Degli Studi di Roma, Tor Vergata, Roma, Italy.
| | - Luca Re
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Alessandra Pigni
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Antonino Tallarita
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Silvia Cilluffo
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Augusto Tommaso Caraceni
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Maura Lusignani
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| |
Collapse
|
35
|
Míguez-Navarro MC, Escobar-Castellanos M, Guerrero-Márquez G, Rivas-García A, Pascual-García P. Pain Prevalence Among Children Visiting Pediatric Emergency Departments. Pediatr Emerg Care 2022; 38:228-234. [PMID: 35482496 DOI: 10.1097/pec.0000000000002580] [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: 11/25/2022]
Abstract
OBJECTIVES The main purpose of this study was to investigate the prevalence, characteristics, and intensity of children's pain in emergency departments. The secondary purpose was to evaluate the interobserver agreement regarding the level of pain perceived by professionals, parents, and children. METHODS This was a multicenter, survey-based research study on 0- to 18-year-old patients visiting 1 of the 15 hospitals that form part of the Working Group on Analgesia and Sedation of the Spanish Society of Pediatric Emergency Medicine between October and December 2018. The surveys recorded pain presence, intensity, characteristics, and location. RESULTS The study included 1216 surveys. At the time of the interview, 646 patients were experiencing pain, a prevalence of 53.1% (95% confidence interval, 50.3%-55.9%), with 25.38% reporting mild, 36.68% moderate, and 37.46% intense pain. Among the patients, 29.9% had abdominal pain and 14.1% pain in their legs.The pain lasted less than 24 hours in 48.2% of the patients, whereas only 3.0% experienced pain during more than 15 days. The parents of 50.7% of the children had provided an analgesic at home.Interrater agreement regarding pain levels was k = 0.35 between professionals and children, k = 0.38 between children and parents, and k = 0.17 between parents and professionals. For children unable to cooperate, the agreement between professional/child and the parents was k = 0.11. CONCLUSIONS Pain is a common symptom among emergency department patients, and its evaluation should therefore be obligatory. We found low interrater agreement on pain levels between patients, professionals, and parents, which confirms how difficult it is to accurately evaluate pain intensity.
Collapse
|
36
|
Ali S, Gourlay K, Yukseloglu A, Rosychuk RJ, Ortiz S, Watts R, Johnson DW, Carleton B, Le May S, Drendel AL. Quantifying the intensity of adverse events with ibuprofen and oxycodone: an observational cohort study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001428. [PMID: 36053661 PMCID: PMC9131055 DOI: 10.1136/bmjpo-2022-001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To quantify the frequency and intensity of adverse events (AEs), commonly known as side effects, experienced by children receiving either ibuprofen or oxycodone for pain management following an acute fracture. Secondary objectives were to quantify functional outcome impairment and describe demographic and clinical characteristics associated with AEs. DESIGN Observational cohort study. SETTING Paediatric emergency department. PATIENTS Patients (n=240) aged 4-16 years diagnosed with an acute fracture. INTERVENTION Prescribed either ibuprofen (n=179) or oxycodone (n=61) for pain. MAIN OUTCOME MEASURES Families were called for the first 3 days after discharge to report the presence and intensity of AEs and their child's functional outcomes (ability to eat, sleep, play or attend school). RESULTS On day 1, children using oxycodone were more likely to report any AE (χ2 1=13.5, p<0.001), nausea (χ2 1=17.0, p<0.001), vomiting (χ2 1=11.2, p<0.001), drowsiness (χ2 1=13.7,p<0.001), constipation (χ2 1=8.9, p=0.003) and dizziness (χ2 1=19.1, p<0.001), compared with those using ibuprofen. Children receiving oxycodone reported greater severity of abdominal pain (oxycodone: mean 5.4 SD 3.1; ibuprofen mean 2.5 SD 1.4, F1 13=6.5, p=0.02) on day 1 and worse intensity of constipation (oxycodone: mean 4.9 SD 2.1; ibuprofen mean 3.2 SD 2.2, F1 33=4.5, p=0.04) over all 3 days. Use of oxycodone was associated with an increased odds of experiencing an AE on day 1 (OR=1.31 (95% CI 1.13 to 1.52)). Higher pain scores (OR=1.50 (95% CI 1.12 to 2.01)), lower extremity fracture (OR=1.25 (95% CI 1.07 to 1.47)) and undergoing ED sedation (OR=1.16 (95% CI 1.01 to 1.34)) were associated with missing school. Higher pain scores (OR=1.50 (95% CI 1.14 to 1.97)) and lower extremity fractures (OR=1.23 (95% CI 1.07 to 1.43)) were also associated with less play. CONCLUSIONS Oxycodone is associated with more frequent AEs overall, higher intensity gastrointestinal AEs and greater functional limitations compared with ibuprofen. Lower extremity fractures cause more functional limitations than upper extremity fractures. Clinicians should consider these differences when providing fracture pain care for children.
Collapse
Affiliation(s)
- Samina Ali
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada .,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Katie Gourlay
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aran Yukseloglu
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Silvia Ortiz
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Rick Watts
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - David W Johnson
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bruce Carleton
- Division of Translational Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sylvie Le May
- Faculty of Nursing, Universite de Montreal, Montreal, Quebec, Canada
| | - Amy L Drendel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
37
|
Moharrami M, Ali S, Dick BD, Moeinvaziri F, Amin M. The relationship between nitrous oxide sedation and psychosocial factors in the pediatric outpatient setting. Paediatr Anaesth 2022; 32:548-555. [PMID: 35020963 DOI: 10.1111/pan.14395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Moderate sedation using nitrous oxide (N2 O) has become common in pediatric dentistry. However, less is known regarding the role of patients' characteristics and psychosocial factors in their cooperative behavior during dental procedures with N2 O. AIMS This study aimed to examine pediatric dental patients' behaviors while undergoing N2 O sedation and to measure the associations between child's cooperative behavior and demographic, physiological responses, and psychosocial factors. METHODS In this within-subject observational study, participants received 40% N2 O/O2 , by nasal hood, for non-surgical dental procedures. The main outcome measure was the extent of cooperative behaviors, as assessed by the Frankl scale at five timepoints, namely T1: pre-administration of N2 O, T2: post-administration of N2 O, T3: dental injection, T4: dental treatment, and T5: post-procedure administration of 100% O2 . Predictors included age, sex, psychosocial factors reported using the Parenting Style and Dimension Questionnaire and Spence Children Anxiety Scale, as well as pulse rate, respiratory rate, and oxygen saturation. The Wilcoxon signed-rank test and generalized estimation equation were used for data analyses. RESULTS In 80 children with a mean age of 7.2 (2.2) years, administration of N2 O was significantly associated with cooperative behaviors (odds ratio [OR]:2.62, confidence interval [CI]: 1.46-4.70, p = .001) when adjusted for other predictors. There was no interaction between any of the predictors and N2 O sedation on behaviors. Except for the authoritative parenting style (OR: 1.96, CI: 1.16-3.31, p = .012), which predicted more cooperative behaviors, other predictors were not associated with behavioral outcomes. CONCLUSION In children sedated with N2 O, behavior was independent of the child's demographic and psychosocial factors. While sedated, demographics, vital signs, and anxiety did not contribute to behavior management. However, screening for parenting style may help predict the child's behavioral response.
Collapse
Affiliation(s)
- Mohammad Moharrami
- Faculty of Medicine & Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce D Dick
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fardad Moeinvaziri
- Faculty of Medicine & Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Amin
- Faculty of Medicine & Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
38
|
Takagi D, Less Elazari S, Shles A, Yechiam H, Schujovitzky D, Rosenbloom E. Pain management of upper limb fractures in pediatric emergency department versus general orthopedics emergency department. Eur J Pediatr 2022; 181:1541-1546. [PMID: 35059827 DOI: 10.1007/s00431-021-04310-w] [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: 07/12/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/01/2022]
Abstract
UNLABELLED Under treatment of pain is frequently reported in children even in conditions associated with severe pain such as fractures. Recent literature supports adequate and early pain treatment because extreme and uncontrolled pain can lead to hyperalgesia. Since 2017, the treatment of pediatric orthopedic cases in the "Meir" Medical Center was gradually shifted from the orthopedic general emergency department to the pediatric emergency department. The objective was to examine the differences in pain management between the orthopedic and pediatric emergency departments. Upper limb fractures were chosen as a representing case. This retrospective cohort study included children aged 0-18 years that suffered from an upper limb fracture and were admitted to the emergency department in the years 2016 and 2018. In our study, a total of 2520 children suffered from an upper limb fracture and were treated at the Meir Medical Center during the study period. 959 of these children were treated during 2016 in the general emergency department, and 1561 were treated in the pediatric emergency department during 2018. The group characteristics were similar. In the pediatric emergency department compared to general emergency department group, more children received analgesic treatment (47.85% versus 30.4%, p < .001), more opiates were given (13.9% versus 5.3%, p < .001), and the analgesic treatment was more adequate to pain severity. Additionally, sedation was performed more frequently in the pediatric emergency department (21.6% versus 9.5%, p < .001), especially for dislocated fractures (81.5% versus 31.4%, p < .001). COMPLICATIONS Length of stay, surgery, hospitalization, and recurrent referral rates were similar between the two groups. CONCLUSIONS The transfer of orthopedic pediatric cases to the pediatric emergency department showed a notable improvement in pain management without an increase in complications or emergency department length of stay. WHAT IS KNOWN • Pain management and control is a major issue to address in their treatment. • Traumatic injuries and especially fractures are common causes for ED admissions. WHAT IS NEW • Comparing pain management and upper limb fractures treatment between general and pediatric ED. • Pain is better treated in the PED than in the GED, without an increased rate of complications.
Collapse
Affiliation(s)
- Dania Takagi
- Department of Pediatrics, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba, 4428164, Israel. .,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - Saharon Less Elazari
- Department of Pediatrics, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba, 4428164, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Shles
- Department of Pediatrics, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba, 4428164, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Yechiam
- Department of Pediatrics, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba, 4428164, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Dana Schujovitzky
- Department of Pediatrics, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba, 4428164, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rosenbloom
- Department of Pediatrics, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba, 4428164, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
39
|
Chumpitazi CE, Chang C, Atanelov Z, Dietrich AM, Lam SH, Rose E, Ruttan T, Shahid S, Stoner MJ, Sulton C, Saidinejad M. Managing acute pain in children presenting to the emergency department without opioids. J Am Coll Emerg Physicians Open 2022; 3:e12664. [PMID: 35310402 PMCID: PMC8918119 DOI: 10.1002/emp2.12664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 02/06/2023] Open
Abstract
Pediatric pain is challenging to assess and manage. Frequently underestimated in children, untreated pain may have consequences including increased fear, anxiety, and psychological issues. With the current opioid crisis, emergency physicians must be knowledgeable in both pharmacologic and non‐pharmacologic approaches to address pain and anxiety in children that lead to enhanced patient cooperation and family satisfaction. This document focuses pain management and distress mitigation strategies for the brief diagnostic and therapeutic procedures commonly performed.
Collapse
Affiliation(s)
- Corrie E. Chumpitazi
- Department of Pediatrics Division of Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Cindy Chang
- Department of Pediatrics, Division of Emergency Medicine Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Zaza Atanelov
- North Florida Regional Medical Center Emergency Department HCA/University of Central Florida College of Medicine Consortium Florida USA
| | - Ann M. Dietrich
- Department of Pediatrics and Emergency Medicine University of South Carolina College of Medicine Greenville North Carolina USA
| | - Samuel Hiu‐Fung Lam
- Department of Emergency Medicine Sutter Medical Center Sacramento Sacramento California USA
| | - Emily Rose
- Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Tim Ruttan
- Dell Children's Medical Center, Department of Pediatrics The University of Texas at Austin Dell Medical School, US Acute Care Solutions Austin Texas USA
| | - Sam Shahid
- American College of Emergency Physicians Irving Texas USA
| | - Michael J. Stoner
- Nationwide Children's Hospital The Ohio State University College of Medicine Columbus Ohio USA
| | - Carmen Sulton
- Emory University School of Medicine Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Mohsen Saidinejad
- Department of Emergency Medicine Harbor UCLA Medical Center Torrance California USA
| | | |
Collapse
|
40
|
Hartshorn S, Durnin S, Lyttle MD, Barrett M. Pain management in children and young adults with minor injury in emergency departments in the UK and Ireland: a PERUKI service evaluation. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001273. [PMID: 36053599 PMCID: PMC8943777 DOI: 10.1136/bmjpo-2021-001273] [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: 08/27/2021] [Accepted: 03/03/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Management of acute pain should commence at the earliest opportunity, as it has many short-term and long-term consequences. A research priority of Paediatric Emergency Research in the UK and Ireland (PERUKI) was to examine paediatric pain practices. OBJECTIVE To describe the outcomes for paediatric pain management of minor injuries presenting to emergency departments (EDs) across PERUKI. METHODS A retrospective service evaluation was performed over a 7-day period in late 2016/early 2017 across PERUKI sites, and analysis performed using an adapted Donabedian framework. Patients under 16 years presenting with minor trauma were eligible, and data were collected on prehospital management, pain assessment, analgesia administered and injury diagnosed. RESULTS Thirty-one sites submitted data on 3888 patients. There were 111 missed cases (missed rate 3.6%). The most common injuries were sprains, lacerations, contusions/abrasions and fractures. Documentation of receiving analgesia before arrival in ED occurred in 21% of patients (n=818). A pain assessment was documented in 57.5% of patients (n=2235) during their ED visit, and 3.5% of patients had their pain reassessed (n=138). Of the patients who presented in severe pain (pain score 7-10 or rated severe), 11% were reassessed. Site variability of initial pain assessment ranged from 1.4% to 100% (median 62%). The characteristics of the top quartile performing centres against the bottom quartile performing centres based on completion rate of initial pain scores were identified. CONCLUSION Pain assessment was documented in under 60% of children with minor injury, re-assessment of pain was almost completely absent, data and outcomes were missing in a substantial volume of patients, indicating that pain management and the associated outcomes have not been adequately addressed and prioritised within existing network structures and processes.
Collapse
Affiliation(s)
- Stuart Hartshorn
- Paediatric Emergency Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK .,Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Sheena Durnin
- Paediatric Emergency Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Paediatric Emergency Medicine, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Mark D Lyttle
- Paediatric Emergency Medicine, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Michael Barrett
- Paediatric Emergency Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,Women's and Children's Health, University College Dublin, Dublin, Ireland
| | | |
Collapse
|
41
|
Pain Evaluation in the Paediatric Emergency Department: Differences in Ratings by Patients, Parents and Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042489. [PMID: 35206676 PMCID: PMC8872586 DOI: 10.3390/ijerph19042489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022]
Abstract
The pain experienced by paediatric patients is rarely evaluated in emergency departments. The aim of the present study was to compare the degree of conformity in patients’ pain severity when assessed by themselves (if possible), their parents and a triage nurse trained in pain evaluation. Methods: A cross-sectional observational study was conducted at a tertiary paediatric emergency department in Eastern Poland involving children (aged six months to eighteen years), their parents and nurses. The patients had their pain assessed while collecting a medical history. For children ≥ four years of age, the Numerical Rate Scale was used by patients, parents and nurses to evaluate pain. Patients under four years of age were evaluated by parents and nurses using the FLACC scale. Results: Eighty patients and their parents were enrolled in the study. For children ≥ four years, patients rated their pain significantly higher than both their parents (p = 0.03) and nurses (p < 0.001), with the latter group producing the lowest scores. For children under four years of age, parental pain assessments did not significantly differ from those of nurses. Conclusion: Compared to the patients themselves and their parents, nurses tended to assign lower pain scores for children. Pain should be assessed on admission to the ED and, whenever possible, by the patients themselves.
Collapse
|
42
|
Zahraei-Moghaddam SM, Haghighatafshar M, Shekoohi-Shooli F, Miladi S, Farhoudi F. Toward applying a device to reduce motion artifact during imaging: a randomized controlled trial. Expert Rev Med Devices 2022; 19:189-194. [PMID: 35081856 DOI: 10.1080/17434440.2022.2035215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE One of the most critical problems in different types of medical imaging modalities is unwanted patient movement during imaging procedures, which mainly occurs because of stress, anxiety, and restlessness in patients, resulting in poor image quality and decreased diagnostic accuracy. METHODS This prospective, randomized, double-blinded, controlled trial comprised 267 patients who underwent MPI, randomly divided into three groups; Group I: streaming music with a special binaural beat frequency (MBB); Group II: streaming simple music (SM) and Group III: control group. Anxiety level was determined by DASS (Depression Anxiety Stress-Scale) questionnaire and heart rate was monitored. RESULTS Stress and anxiety scores were significantly lower in the MBB group compared with both SM and control group (P˂0.0001). Additionally, a significant decrease in heart rate of patients who were in the MBB group in comparison with the SM (p=0.005) and control group (P=0.018) was observed. The study revealed a significant decrease in motion artifact in the MBB group compared with the SM (P=0.003) and control (P˂0.0001) groups. CONCLUSIONS Using the proposed device capable of streaming special binaural beat frequency embedded music can cause a significant reduction in anxiety level, heart rate, and consequently motion artifact. This method can be useful during the imaging procedure due to several reasons. First, this can cause a significant reduction in motion artifacts. Next, anxiety and stress can be reduced significantly due to the application of special binaural beat frequency embedded music during an imaging procedure. Then, a significant reduction in post-imaging stress and anxiety scores was achieved after using it. Finally, binaural beat frequency embedded music leads to imaging repetition avoidance.
Collapse
Affiliation(s)
- Seyed Mohsen Zahraei-Moghaddam
- Nuclear Medicine and Molecular Imaging Research Center, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Haghighatafshar
- Nuclear Medicine and Molecular Imaging Research Center, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Shekoohi-Shooli
- Nuclear Medicine and Molecular Imaging Research Center, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100, Chieti, Italy
| | - Shima Miladi
- Clinical Research Development Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farinaz Farhoudi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
43
|
Bar Am N, Thull-Freedman J, Ali S. Practice Patterns and Assessment of Needs for Pediatric Pain Management in Alberta Emergency Departments. OPEN ACCESS EMERGENCY MEDICINE 2022; 13:587-594. [PMID: 34992476 PMCID: PMC8714010 DOI: 10.2147/oaem.s337900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Many rural and community emergency departments (EDs) experience barriers to providing optimal pain care to children. In preparation for a quality improvement initiative, our team conducted a provincial pediatric pain management practice and needs assessment. Methods An online survey was sent to ED administrators and educators from March to May 2017. Themes included pain assessment, pain and distress management strategies, available resources, education, barriers to care, and opportunities for improvement. Results Forty-five respondents, from 31 EDs representing all five geographic health zones in Alberta, completed the survey. Use of a pain assessment tool was reported at 93.5% (29/31 sites) of the sites. Topical anesthesia was employed “most of the time” before suturing at 67% (18/27) of sites, versus 15% (4/27) before blood work or IV insertion. Eighty-one percent (22/27) of sites reported physically restraining children for procedures “often”, while 37% (10/27) reported use of comfort positioning “often”. Digital distraction devices were available at 37% (10/27) of sites. Reported challenges included lack of resources (33.3%, 12/36), staff education/knowledge (33.3%, 12/36), and absent policies/poor policy adherence (25.0%, 9/36). Opportunities for improvement included staff member education (73.5%, 25/34) and more resources (58.8%, 20/34). Respondents rated their site’s overall ability to manage children’s pain as 50/100 [IQR:21,61]. Conclusion General EDs report providing suboptimal children’s pain care, with use of physical restraint for medical procedures, and under-utilization of evidence-based, inexpensive treatment options. There are many gaps in children’s pain care in rural and community EDs which could be addressed through collaborative quality improvement initiatives.
Collapse
Affiliation(s)
- Neta Bar Am
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, and Women and Children's Research Institute, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
44
|
Ding Y, Yin H, Wang S, Meng Q, Yan M, Zhang Y, Chen L. Effectiveness of clown intervention for pain relief in children: A systematic review and meta-analysis. J Clin Nurs 2022; 31:3000-3010. [PMID: 34985166 DOI: 10.1111/jocn.16195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/20/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pain is common in children receiving medical procedures, and there is a lack of adequate awareness and management. In addition, children who undergo medical procedures involving pain may also experience stress, crying and prolonged hospitalisation. Clown intervention is a promising nonpharmacological intervention. However, studies on the effectiveness of clown intervention in pain management have reported conflicting findings. OBJECTIVE To evaluate the effectiveness of clown intervention in relieving pain in children, as well as its effects on cortisol levels, crying duration and length of hospital stay. DESIGN Systematic review and meta-analysis of randomised controlled studies. DATA SOURCES PubMed, Web of Science (SCI), Embase, PsycINFO, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Weipu (VIP), Wanfang Data and SinoMed were systematically searched from inception date to December 31, 2020. REVIEW METHODS Two reviewers independently used the Cochrane risk of bias tool to assess the risk of bias of the included studies. Meta-analysis was conducted when data were available, otherwise, a narrative description was provided. Data were analysed using Review Manager 5.3. The review process is reported according to PRISMA. RESULTS Nine studies including 852 children met the inclusion criteria. The results showed that compared with standard care, clown intervention was beneficial for relieving pain. Further subgroup analysis showed that it was more effective with children aged 2-7 years. The duration of crying after the procedure and the length of stay were shortened, but there was no significant difference in cortisol levels. CONCLUSION Clown intervention may be a promising way to relieve acute pain in children, especially those aged 2-7 years. It also seems to shorten the duration of crying and the length of hospital stays, but the effect on cortisol levels is still uncertain. More high-quality randomised controlled trials are needed to confirm these results and take into account different age groups, cultural backgrounds and specific populations.
Collapse
Affiliation(s)
- Yiwen Ding
- School of Nursing, Jilin University, Changchun, China
| | - Huiru Yin
- School of Nursing, Jilin University, Changchun, China
| | - Shuo Wang
- School of Nursing, Jilin University, Changchun, China
| | - Qiuyan Meng
- School of Nursing, Jilin University, Changchun, China
| | - Mingli Yan
- School of Nursing, Jilin University, Changchun, China
| | - Yining Zhang
- First Hospital of Jilin University, Changchun, China
| | - Li Chen
- School of Nursing, Jilin University, Changchun, China.,Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China
| |
Collapse
|
45
|
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.
Collapse
Affiliation(s)
| | | | | | - Virginia B Young
- Emergency Services, Children's Health Children's Medical Center Dallas, Dallas, TX
| | | |
Collapse
|
46
|
Poirée M, Duplan M, Letort-Bertrand M, Thouvenin S, Deparis M, Galland F, Aladenise C, Lervat C. Soins de support en oncologie pédiatrique ou le respect des besoins fondamentaux des enfants et adolescents. Bull Cancer 2022; 109:557-567. [DOI: 10.1016/j.bulcan.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
|
47
|
Kumar K, Ali S, Sabhaney V, Trottier E, Drendel A, Bhatt M, Boisvert L, Poonai N. Anxiolysis for laceration repair in children: a survey of pediatric emergency providers in Canada. CAN J EMERG MED 2022; 24:75-83. [PMID: 34746980 DOI: 10.1007/s43678-021-00210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/24/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Intranasal dexmedetomidine is a potentially effective anxiolytic but its role in pediatric laceration repair is only emerging. Future trials and clinical adoption of intranasal dexmedetomidine depend on understanding pediatric emergency providers' practice patterns surrounding anxiolysis and perceived barriers to intranasal dexmedetomidine for anxiolysis during suture repair in children. Our objectives were to characterize these parameters to inform future research and facilitate clinical adoption. METHODS We conducted an online survey of pediatric emergency physician members of Pediatric Emergency Research Canada from September to December 2020. Questions pertained to perceptions of anxiolysis for suture repair, with a focus on intranasal dexmedetomidine. The primary outcome was anxiolysis for suture repair. Data were reported using descriptive statistics. RESULTS The response rate was 155/225 (68.9%). During suture repair, 127/148 (86%) believed that > 25% of young children experience distress requiring physical restraint. 116/148 (78%) would provide anxiolysis, mainly intranasal benzodiazepines (100/148, 68%). Only 6/148 (4%) would provide intranasal dexmedetomidine but 95/148 (64%) would consider it if there was evidence of benefit. The most common perceived barriers to intranasal dexmedetomidine included inadequate personal experience (114/145, 79%) and lack of access (60/145, 41%). CONCLUSIONS Most Canadian pediatric emergency providers believe that laceration repair in a young child is distressing. Despite questionable efficacy, most would provide intranasal benzodiazepines, but would consider intranasal dexmedetomidine if there was evidence of benefit.
Collapse
Affiliation(s)
- Kriti Kumar
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Vikram Sabhaney
- Department of Pediatrics, Faculty of Medicine, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Evelyne Trottier
- Département d'Urgence Pédiatrique, CHU Sainte-Justine, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Amy Drendel
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Leslie Boisvert
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Naveen Poonai
- Departments of Paediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 800 Commissioners Road East, London, ON, N6A 2V5, Canada.
- Division of Pediatric Emergency Medicine, Children's Health Research Institute, London Health Sciences Centre, London, ON, Canada.
| |
Collapse
|
48
|
Clinical Interpretation of Self-Reported Pain Scores in Children with Acute Pain. J Pediatr 2022; 240:192-198.e2. [PMID: 34478746 PMCID: PMC8712366 DOI: 10.1016/j.jpeds.2021.08.071] [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: 04/19/2021] [Revised: 07/06/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify self-reported pain scores that best represent categories of no pain, mild, moderate, and severe pain in children, and a pain score that accurately represents a child's perceived need for medication, that is, a minimum pain score at which a child would want an analgesic. STUDY DESIGN Prospective cross-sectional cohort study of children aged 6-17 years presenting to a pediatric emergency department with painful and nonpainful conditions. Pain was measured using the 10-point Verbal Numerical Rating Scale. Receiver operating characteristic -based methodology was used to determine pain scores that best differentiated no pain from mild pain, mild pain from moderate pain, and moderate pain from severe pain. Descriptive statistics were used to determine the perceived need for medication. RESULTS We analyzed data from 548 children (51.3% female, 61.9% with a painful condition). The scores that best represent categories of pain intensity are as follows: 0-1 for no pain; 2-5 for mild pain; 6-7 for moderate pain; and 8-10 for severe pain. The area under the curve for the cut points differentiating each category ranged from 0.76 to 0.88. The median pain score representing the perceived need for medication was 6 (IQR, 4-7; range, 0-10). CONCLUSIONS We identified population-level self-reported pain scores in children associated with categories of pain intensity that differ from scores conventionally used. Implementing our findings may provide a more accurate representation of the clinical meaning of pain scores and reduce selection bias in research. Our findings do not support the use of pain scores in isolation for clinical decision making or the use of a pain score threshold to represent a child's perceived need for medication.
Collapse
|
49
|
Ravichandran Y, Parker S, Farooqi A, DeLaroche A. Bladder Stimulation for Clean Catch Urine Collection: Improved Parent and Provider Satisfaction. Pediatr Emerg Care 2022; 38:e29-e33. [PMID: 34475366 DOI: 10.1097/pec.0000000000002524] [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: 11/25/2022]
Abstract
OBJECTIVES Previous studies have demonstrated the efficacy of fluid intake with suprapubic and lumbar paravertebral massage for clean catch urine (CCU) collection in infants. We investigated the acceptability and feasibility of integrating this bladder stimulation technique (BST) into routine care in the pediatric emergency department (PED). METHODS This was a prospective cohort study. Infants less than 6 months of age requiring a urinalysis and urine culture as part of their PED visit were recruited. All PED nurses and technicians received a standardized training outlining the BST using a video module and print materials. Success rates, bacterial contamination, parental perception of patient distress, and parent and provider satisfaction with the BST for CCU collection were compared with urethral catheterization. RESULTS A total of 124 patients were recruited. The BST was successful in 38% (47/124) with a median time to void of 73 seconds (interquartile range: 19, 151). The BST was more likely to be successful in infants less than 90 days (53%; 95% confidence interval, 0.075-0.046; P = 0.005). A urinary tract infection was diagnosed in 4% of patients, with no significant differences between BST (1/47; 2%) and catheterization (4/59; 7%; P = 0.65). Patients experienced less discomfort during the BST compared with catheterization (mean numeric rating scale score, 2/10 vs 6/10; P < 0.001), and the BST was viewed positively by both parents and providers. Compared with catheterization, parents were significantly more satisfied with the BST (BST, 98%; catheterization, 58%; P < 0.001) and were more likely to consent to the BST in the future (BST, 98%; catheterization, 69%; P < 0.001). Most providers reported that the BST was well tolerated by participants (46/47; 98%), and providers felt that the BST improved parental satisfaction with the clinical encounter (46/47; 98%). CONCLUSION The BST for CCU collection is a well-tolerated and well-received approach that can easily be implemented into clinical practice with minimal training.
Collapse
Affiliation(s)
| | - Sarah Parker
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
| | - Ahmad Farooqi
- Children's Research Center of Michigan, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
| | - Amy DeLaroche
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
| |
Collapse
|
50
|
Mintegi S, Maconochie IK, Waisman Y, Titomanlio L, Benito J, Laribi S, Moll H. Pediatric Preparedness of European Emergency Departments: A Multicenter International Survey. Pediatr Emerg Care 2021; 37:e1150-e1153. [PMID: 32398594 DOI: 10.1097/pec.0000000000001934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Children and adolescents often lack optimal emergency care. The objective of the study was to assess the level of preparedness of European emergency departments (EDs) for pediatric patients. METHODS This was an international multicenter Internet-based survey of EDs with attending children and adolescents younger than 18 years in 101 EDs from 21 countries. Questionnaires were based on the recommendations in the consensus document published by the International Federation for Emergency Medicine, which defines quality of care standards for children aged 0 to 18 years in the ED. A multivariate binary logistic regression was performed to identify independent factors that are related to the expected standards of care provided by the EDs. RESULTS Most (95.0%) of the EDs fulfilled more than 50% of the International Federation for Emergency Medicine essential standards of care, and 24 (23.7%) EDs fulfilled more than 80%. Best results were obtained in the standards that related to equipment, departmental policies, procedures, and protocols, and being able to stabilize an ill or injured child. Worst results were associated with inadequate staffing levels, quality, and safety; adolescents, mental health, and substance misuse delivery issues; and major incidents. Being included in a multicenter international research network was the unique independent factor associated with a good level of preparedness of the EDs for pediatric cases. CONCLUSIONS Overall, surveyed European EDs fit well the essential standards of pediatric emergency care. Certain improvement actions are required to guarantee that essential standards of care for pediatric emergency care are always fulfilled in European EDs.
Collapse
Affiliation(s)
- Santiago Mintegi
- From the Paediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Ian K Maconochie
- Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS healthcare Trust, London, UK
| | - Yehezkel Waisman
- Department of Emergency Medicine, Schneider Children's Medical Centre of Israel, Petah Tikva, Israel
| | - Luigi Titomanlio
- Paediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Paris
| | - Javier Benito
- From the Paediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Said Laribi
- Emergency Medicine Department, School of Medicine and CHU Tours, Tours University, Tours, France
| | - Henriette Moll
- Sophia's Children's Hospital-Erasmus MC, Rotterdam, the Netherlands
| |
Collapse
|