Evolution in acute pain assessment and treatment in the paediatric emergency department of a tertiary health care centre

Abstract

Background: Paediatric pain remains one of the most misunderstood, under-diagnosed and under-treated medical problems in children.

Aim: To investigate the accuracy of acute pain assessment and management in the Paediatric Emergency Department in Lithuanian University of Health Sciences Hospital.

Methods: We performed a retrospective record analysis before (the year 2017) and after (the year 2018) paediatric pain training course was conducted. In total, 1,000 randomly selected outpatient records were analysed. We divided all patients into two groups: group A records from 2017 and group B from 2018. Patients were further divided into trauma and non-trauma and subdivided into four different age groups. We collected patient age, the origin of pain, pain characteristics, pain score and medication.

Results: We compared 500 children in each group. Groups A and B consisted of 154 (30.8%) and 116 (23.2%) trauma patients, respectively. The pain was scored less in group A (420 children; 84%) compared to group B (94.4% of all 500 patients, p < .001). In all age groups, the pain was assessed more often, and pain medication was prescribed more often in group B compared to group A (p < .001). There was a tendency to assess pain more often in group A non-trauma patients (p = .054). However, pain relief in trauma patients was less adequate compared to non-trauma.

Conclusion: Our research showed improvement in pain evaluation and treatment after systemic and local changes in paediatric emergency department (PED). In group B, pain was evaluated more frequently, and patients received pain medication more often than in group A. Teenagers are still less likely to receive analgesics than toddlers. Tendency remains to give fewer painkillers to trauma patients compared to non-trauma children.

Significance: This is one of the few studies in the Baltic region analysing changes in children's pain assessment and management in the PED after systemic and local adjustments. Our data show an impact of systemic changes and a specialized education focused on improving knowledge in acute pain diagnostics and management of medical professionals leading to better patient care.