Investigating the use of physical restraint of children in emergency departments: A Scandinavian survey

Abstract

Aim The aim of the study is to describe the current frequency of physical restraint and the use of analgesics and sedatives for treating pediatric pain in emergency departments (EDs) in Scandinavia. Methods We performed a nation‐wide electronic survey asking nurses in the emergency departments in Denmark, Norway, and Sweden about their experience treating children in pain. Results Responses from 103 Danish, Norwegian and Swedish nurses were included (79% response rate). Physical restraint was reported used at 79% [70.0‐85.9] (N = 78) of the surveyed departments (DK: 96%, NO: 67%, SE: 77%) with two participants reporting daily use of physical restraint. Paracetamol was available at all departments and used most frequently. Sedation was available at 88% [78.8‐92.0] of the departments with midazolam as the most recurrent sedative (83%, [74.8‐89.4]). Seventy‐three percent of respondents reported a need for better treatments. Lack of education was the most frequently reported obstacle for providing both pain treatment (29%) and sedation (43%) followed by lack of guidelines. Conclusion Physical restraint of children during painful procedures is used in the majority of Scandinavian emergency departments (79%). There appears to be a lack of local guidelines for both pain treatment and sedation.

A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children

“…The lack of evidence may have prevented physicians from considering IN DEX as an option for PSA for painful procedures in the ED [ 7 ]. In addition, the lack of alternatives may have contributed to the use of physical restraints [ 6 ]. We believe that despite incomplete inclusion, and therefore not reaching calculated sample size, these results show clinically relevant information in relation to IN DEX analgesic and sedative effect during painful procedures in young children.…”

“…In addition, the absence of effective procedural sedation and analgesia (PSA) can result in a negative experience for both children and their parents, which in turn can impact future procedures or even hospital visits [ 4 , 5 ]. Despite the awareness, children still fail to receive adequate PSA due to lack of knowledge and evidence on different possibilities for PSA as reported in recent surveys from Scandinavia and Canada [ 6 , 7 ].…”