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

Abstract

Background: Painful experiences are common among hospitalized children. Long-term negative biopsychosocial consequences of under-treated pain are recognized. Aims: The study benchmarks pain prevalence, assessment, and treatments as a first step to improve pain care in a Canadian tertiary hospital. Methods: Single-day audits were undertaken on the pediatric ward (PW), emergency department (ED), and maternal services (MS). Participants (child or caregiverproxy) reported hospital pain experiences in the preceding 24 hours; medical records were reviewed for assessment and treatment. Results: Among 84 participants, pain prevalence ranged from 75-88%; mean pain intensity ranged from 5.7-6.5/10. Prevalence of moderate to severe pain was 78% on PW, 65% in ED, and 55% on MS. Needle pokes were the most frequent cause of worst pain. Documentation of pain assessment varied by setting (PW, 93%; ED, 13%; MS, 0%). Documented maximum pain scores were significantly lower compared to participant report (mean difference 4.5/10, SD=3.1, p<0.0001). A total 29% (6/21) of infants with heel lance or injection received breastfeeding or sucrose, and 29% (7/24) of participants receiving other needle procedures had documented or reported topical lidocaine use. All participants on MS underwent needle procedures. Conclusions: Pain is experienced commonly by infants and children in PW, ED, and MS. Pain assessment documentation is not routine and underestimates participant report. Evidence-based pain management strategies are underutilized. An institution-wide quality improvement approach is required to address pain care. Pain assessment and needle pain prevention and treatment should be prioritized in these pediatric acute care and newborn care settings.

Cross-sectional evolution of pain management policies and practices in Portuguese pediatric emergency departments

“…Unlike previous studies (Brudvik et al, 2017;Senger et al, 2021), there was high percentage of treatment of severe pain for the years studied, as well as widespread use of opioids in this context.…”

“…Despite ongoing improvements in pain relief, pediatric pain management is still insufficient worldwide(Ali et al, 2014; Farhat et al, 2013; Ferrante et al, 2013; Herd et al, 2009; MacLean et al, 2007; Williams et al, 2019). Ironically, pain induced by health professionals during various routine procedures is often underestimated, being amongst the most common sources of acute pain at the PED(Pancekauskaite and Jankauskaite, 2018; Senger et al, 2021).…”

Call to focus on digital health technologies in hospitalized children's pain care: clinician experts' qualitative insights on optimizing electronic medical records to improve care

“…Worldwide studies demonstrate that most hospitalized children (78%-94%) experience acute pain 8,14,29,37,38 that is often inadequately assessed and undertreated. In 2011, research involving 8 Canadian pediatric hospitals demonstrated the regular occurrence of painful procedures, yet less than one-third of these children had a documented pain intervention.…”

“…31 More recent studies from Canada, Europe, and South Africa show the continued high prevalence (24% to 63%) of moderate to severe acute pain reported in hospitalized children, commonly from needle procedures and often performed without adequate analgesic strategies. 8,29,37,40 Critically unwell neonates are particularly vulnerable to undertreated pain. A recent systematic review showed that neonates in a neonatal intensive care unit underwent up to 17 painful procedures each day, 8 most performed without pain relief.…”

“Seeing the light in the shade of it”: primary caregiver and youth perspectives on using an inpatient portal for pain care during hospitalization

“…Pain control is a fundamental human right, yet publications over the years show that hospitalized children face inadequately assessed and undertreated pain. 12,50,61,62 Painful procedures, including needles and medical and surgical conditions, such as trauma, are common. Up to 3 quarters of pediatric patients worldwide suffer moderate to severe pain, most commonly from needle procedures performed with no or inadequate analgesia.…”