Documented Electronic Medical Record-Based Pain Intensity Scores at a Tertiary Pediatric Medical Center: A Cohort Analysis

Solodiuk, Jean C.; Brighton, Hadley; McHale, J.; LoChiatto, Joyce; Logan, Deirdre E.; Sager, Susan L.; Zurakowski, David; Berde, Charles B.

doi:10.1016/j.jpainsymman.2014.01.006

Cited by 18 publications

(13 citation statements)

References 32 publications

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“…Children with developmental and neuromuscular disorders were identified as 1 of 3 subgroups with high pain scores, assessed by using the Individualized Numeric Rating Scale, in a retrospective cohort analysis of more than 1.5 million documented pain scores in a tertiary pediatric medical center during a 3-year period. 15 In children with severe cognitive impairment, the average pain intensity for all sources of nonaccidental pain was 6.1 on a 10-point scale (0 equaling no pain and 10 equaling the worst pain), with an average duration of 6 hours. 9 In those with less impairment, specifically the ambulatory group with accidental pain, the average pain intensity was 3.8, with an average duration of 46 minutes.…”

Section: Pain Frequency and Severity Are Significant In Children Withmentioning

confidence: 99%

Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System

Hauer

Houtrow

Hospice³

2017

Pediatrics

172

156

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Pain is a frequent and significant problem for children with impairment of the central nervous system, with the highest frequency and severity occurring in children with the greatest impairment. Despite the significance of the problem, this population remains vulnerable to underrecognition and undertreatment of pain. Barriers to treatment may include uncertainty in identifying pain along with limited experience and fear with the use of medications for pain treatment. Behavioral pain-assessment tools are reviewed in this clinical report, along with other strategies for monitoring pain after an intervention. Sources of pain in this population include acute-onset pain attributable to tissue injury or inflammation resulting in nociceptive pain, with pain then expected to resolve after treatment directed at the source. Other sources can result in chronic intermittent pain that, for many, occurs on a weekly to daily basis, commonly attributed to gastroesophageal reflux, spasticity, and hip subluxation. Most challenging are pain sources attributable to the impaired central nervous system, requiring empirical medication trials directed at causes that cannot be identified by diagnostic tests, such as central neuropathic pain. Interventions reviewed include integrative therapies and medications, such as gabapentinoids, tricyclic antidepressants, α-agonists, and opioids. This clinical report aims to address, with evidence-based guidance, the inherent challenges with the goal to improve comfort throughout life in this vulnerable group of children.

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Section: Pain Frequency and Severity Are Significant In Children Withmentioning

confidence: 99%

Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System

Hauer

Houtrow

Hospice³

2017

Pediatrics

172

156

View full text Add to dashboard Cite

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“…Patients presenting with sickle cell disease and vaso-occlusive episodes (VOEs) were analyzed separately because of high pain scores and frequent PCA and/or NCA usage. 16…”

Section: Subgroupsmentioning

confidence: 99%

Patient- and Nurse-Controlled Analgesia: 22-Year Experience in a Pediatric Hospital

Donado

Solodiuk

Rangel

et al. 2019

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: Pediatric pain management has rapidly changed over the last 2 decades. In this study, we describe the changing practices and adverse events (AEs) related to patient-controlled analgesia (PCA) and/or nurse-controlled analgesia (NCA) over a 22-year period. METHODS:After institutional review board approval, retrospective data from a single tertiary-care pediatric hospital were collected between 1994 and 2016. Subgroup analyses were done for surgical and medical case patients. We reported the number of times that PCA and/or NCA was ordered annually, the median and interquartile ranges for age, PCA and/or NCA duration and length of stay, and AE frequencies.RESULTS: Over 22 years, 32 338 PCAs and/or NCAs were ordered in this institution. Morphine and hydromorphone were used most commonly. Between 1994 and 2006, initial orders for PCA and/or NCA increased 2.5-fold. After 2007, initial orders for PCA and/or NCA rapidly decreased; after 2013, the decrease continued at a slower rate, with a total of 1007 orders in 2016. This decrease occurred despite increased hospital admissions and surgeries. Between 2007 and 2012, peripheral nerve blocks rapidly increased (10-fold). After 2002, 146 AEs were reported (1.0%). Of those, 50.5% were nonintercepted, and 20.6% were intercepted AEs; 5.5% and 6.2% were preventable and nonpreventable AEs, respectively.CONCLUSIONS: PCA and/or NCA usage continues to be common in pediatric patients, although usage has declined and stabilized in the setting of other emerging methods of analgesia and increases in the number of minimally invasive surgical procedures. The overall rate of AEs was extremely low. However, improvements to eliminate all errors are needed, especially with medications with a great risk of harm (such as opioids).

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“…[2][3][4] When compared with other hospitalized children, children with MC tend to experience pain that is persistent and severe, which may be a result of underlying disease processes, comorbidities, and difficulties in pain assessment. 2 Children with MC may experience both acute pain from fractures, otitis media, and pneumonia 5 and chronic pain from spasticity or neuropathic pain. 6,7 Some children with MC exhibit pain behaviors that are not typically associated with pain such as changes in mental status, laughter, and other vocalizations.…”

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confidence: 99%

Initial Validation of GRASP: A Differential Diagnoses Algorithm for Children With Medical Complexity and an Unknown Source of Pain

Morse

Solodiuk

Greco

et al. 2020

Hospital Pediatrics

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Identifying the source of pain for children with medical complexity (MC) is challenging. The purpose of this study was the initial validation of a tool to guide the medical evaluation for identifying the source of pain in children with MC by using differential diagnoses. The tool is entitled Guidelines for Ruling Out and Assessing Source of Pain (GRASP). METHODS: A mixed-methods approach that included expert review, focus groups, Web-based surveys, and a trial of the GRASP was used to determine validity as well as perceived clinical utility. RESULTS: Focus groups were held with 26 inpatient and outpatient clinicians. Participants consistently responded in support of the GRASP. Participants advised several suggestions for tool organization such as designing the tool as a flow diagram. Seven clinicians participated in Webbased surveys and made specific suggestions for making the GRASP more comprehensive. Six participants trialed the GRASP for 14 children with MC and pain of unknown origin. Overall, participants found that the GRASP was a clinically effective tool for guiding medical evaluation. CONCLUSIONS: These results provide preliminary evidence that the GRASP has content and face validity in evaluating the source of pain in children with MC. This tool can be used to systematically guide clinicians through a balanced approach to evaluation with a goal of determining the pain source, preventing harm, and relieving suffering without unnecessary tests.

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Documented Electronic Medical Record-Based Pain Intensity Scores at a Tertiary Pediatric Medical Center: A Cohort Analysis

Cited by 18 publications

References 32 publications

Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System

Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System

Patient- and Nurse-Controlled Analgesia: 22-Year Experience in a Pediatric Hospital

Initial Validation of GRASP: A Differential Diagnoses Algorithm for Children With Medical Complexity and an Unknown Source of Pain

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