An audit of paediatric pain prevalence, intensity, and treatment at a South African tertiary hospital

Abstract

Introduction: Pain in paediatric inpatients is common, underrecognised, and undertreated in resource-rich countries. Little is known about the status of paediatric pain prevention and treatment in low- and middle-income countries. Objectives: This audit aimed to describe the prevalence and severity of pain in paediatric patients at a tertiary hospital in South Africa. Method: A single-day prospective observational cross-sectional survey and medical chart review of paediatric inpatients at Grey's Hospital, Pietermaritzburg, South Africa. Results: Sixty-three children were included, and mean patient age was 9.7 years (SD 6.17). Most patients (87%) had pain during admission, with 29% reporting preexisting (possibly chronic) pain. At the time of the study, 25% had pain (median pain score 6/10). The worst pain reported was from needle procedures, including blood draws, injections, and venous cannulation (34%), followed by surgery (22%), acute illness/infection (18%), and other procedures (14%). Pharmacological treatments included WHO step 1 (paracetamol and ibuprofen) and step 2 (tramadol, tilidine, and morphine) analgesics. The most effective integrative interventions were distraction, swaddling, and caregiver participation. Although a pain narrative was present in the majority of charts, only 16% had documented pain intensity scores. Conclusion: The prevalence of pain in hospitalised children in a large South African Hospital was high and pain assessment inadequately documented. There is an urgent need for pain education and development of guidelines and protocols, to achieve better pain outcomes for children. This audit will be repeated as part of a quality-improvement initiative.

Cross-sectional study of pediatric pain prevalence, assessment, and treatment at a Canadian tertiary hospital

“…In previous studies, hospitalized children most frequently reported that worst pain was caused by needle pokes with prevalence of 34-40%, followed by surgery or trauma/injury. 14,31 This proportion was observed to vary between the clinical units in our study, lower in the ED where worst pain from acute illness/infection was more common and higher on the MS where needle pain accounted for nearly all worst-pain experiences.…”

“…In similar studies on in-patient pediatric units, documentation rates for pain assessments and treatments during a 24-hour audit ranged from 58% to 78%. 2,14,31 We found documentation to be highest on PW, where pain scores are obtained with routine vital signs every 4-hours; however, maximum scores differed between child/caregiver and chart significantly. Although correct use of validated pain measures is expected in clinical settings, healthcare professionals may have relied on their own overall impression of the child's pain rather than involving the child/caregiver in pain assessment and using validated scales.…”

“…21 In a South African study, 87% of children admitted to an inpatient pediatric unit experienced pain and only 16% had a pain score documented during that time. 31 Previous studies did not include maternal birthing care units where newborns receive routine care. 2,14,21,31 Needle-related procedures are a frequent cause of worst pain among hospitalized pediatric patients.…”

“…31 Previous studies did not include maternal birthing care units where newborns receive routine care. 2,14,21,31 Needle-related procedures are a frequent cause of worst pain among hospitalized pediatric patients. 2,31 In our sample, needle pain was reported as the source of worst pain experienced by 39% (27/69) of children who experienced pain.…”

“…2,14,21,31 Needle-related procedures are a frequent cause of worst pain among hospitalized pediatric patients. 2,31 In our sample, needle pain was reported as the source of worst pain experienced by 39% (27/69) of children who experienced pain. Similarly, among those experiencing moderate to severe pain overall, the most common cause was needle pokes.…”