Main Article Content
Pain, Pediatric Emergency Room, Triage, Extremity trauma, Nurses, Children, PIPER
Background and aim of the work: Pain is one of the most common symptoms in children who access the Pediatric Emergency Room (PER). However, many studies show that it is poorly evaluated and treated during the triage phase and that in many cases algometric scales aren’t used for its evaluation. Faced with this, the Piacenza PER (Italy) implemented the Pain in Pediatric Emergency Room (PIPER) recommendations for the assessment and management of pain from the 1st July 2017. The aim of this study was to detect the possible differences in the trend of the outcomes for the detection and treatment of pain in July-October 2016, 2017, 2018. Methods: A retrospective observational study was chosen. 811 discharge letters of extremity traumatized children aged 0-9 years were analyzed, of which 309 referred to the 2016 quarter, 243 to the 2017 quarter and 259 to the 2018 quarter. Results: In 2016, the pain of 12 patients was assessed out of a total of 309, in 2017 of 227 out of 243 and in 2018 of 245 out of 259. The Chi Square test about assessed and not assessed pain, gave statistically significant value (p = 1.36E-98), comparing 2016vs2017 and gave not significant value comparing 2017vs2018 (p = 0.58). 4 patients were treated during the triage phase in 2016, 68 in 2017 and 70 in 2018. Conclusions: Recommendations introduction has increased the frequency of pain algometric measurements during the triage phase by leading to an improvement in the nursing care outcomes in terms of pediatric pain management.
2. Joint Commission on Accreditation of Healthcare Organizations, Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, II: Joint Commission Resources. 2001. Avaiable at https://www.jointcommission.org/-/media/tjc/documents/resources/pain-management/2001_pain_standardspdf.pdf?db=web&hash=C11475CEAF841C3117874C83193FE8B6.
3. Benini F. Il dolore nel bambino: Il gruppo terapeutico con i genitori, esperienza di sostegno alla genitorialità. [Pain in children: The therapeutic group with parents, experience of parenting support] Quad Acp 2010;17(2):70-3.
4. Krauss BS, Calligaris L, Green SM, Barbi E. Current concepts in management of pain in children in the emergency department. The Lancet 2016;387(10013):83-92.
5. Pretorius A, Searle J, Marshall B. Barriers and Enablers to Emergency Department Nurses’ Management of Patients’ Pain. Pain Manag Nurs 2015;16(3):372-9.
6. Accordo tra il Ministro della Sanità, le Regioni e le Province autonome, 24 maggio 2001. LINEE GUIDA PER LA REALIZZAZIONE DELL’"OSPEDALE SENZA DOLORE". [Agreement of the Minister of Health, the Regions and the Autonomous Provinces, 24 May 2001. GUIDELINES FOR THE REALIZATION OF THE "HOSPITAL WITHOUT PAIN"]. 2001.
7. Approvazione del «Piano sanitario nazionale» 2006-2008. (GU Serie Generale n.139 del 17-06-2006 - suppl. Ordinario n.149). Decreto del Presidente della Repubblica 7 aprile 2006. [Approval of the "National health plan" 2006-2008. (GU General Series n.139 of 17-06-2006 - Suppl. Ordinary n.149). Decree of the President of the Republic April 7, 2006]. Available at: www.gazzettaufficiale.it/eli/id/2006/06/17/06A05518/sg.
8. Ministero della Salute. Il dolore nel bambino. Strumenti Pratici di Valutazione e Terapia. Value Relations International s.r.l. [Ministry of Health. Pain in the child. Practical Assessment and Therapy Tools. Value Relations International s.r.l.]; 2010. Available at: http://www.salute.gov.it/imgs/C_17_pubblicazioni_1256_allegato.pdf.
9. Probst BD, Lyons E, Leonard D, Esposito TJ. Factors affecting emergency department assessment and management of pain in children. Pediatr Emerg Care 2005;21(5):298-305.
10. Petrack EM, Christopher NC, Kriwinsky J. Pain management in the emergency department: patterns of analgesic utilization. Pediatrics 1997;99(5):711-714.
11. Brown JC, Klein EJ, Lewis CW, Johnston BD, Cummings P. Emergency department analgesia for fracture pain. Ann Emerg Med 2003;42(2):197-205.
12. Kircher J, Drendel AL, Newton AS, Dulai S, Vandermeer B, Ali S. Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation. Can J Emerg Med 2014;16(6):449-457.
13. Weng Y-M, Chang Y-C, Lin Y-J. Triage pain scales cannot predict analgesia provision to pediatric patients with long-bone fracture. Am J Emerg Med 2010;28(4):412-417.
14. Ferrante P, Cuttini M, Zangardi T, Tomasello C, Messi G, Pirozzi N, et al. Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals. BMC Pediatr 2013;13(1):139.
15. Benini F, Castagno E, Milani GP. La gestione del dolore nel bambino in pronto soccorso: Survey negli ospedali Italiani. [Pain management in the child in the emergency room: survey in Italian hospitals] Quad ACP 2019;26(3):110-112.
16. Congedi S, Benini F, Rossin S, Pennella A. THE PIPER WEEKEND STUDY. Children’s and adults satisfaction regarding pediatric pain in Italian Emergency Department. Ann Ist Super Sanita 2018;54(1):12-19.
17. Downing A, Rudge G. A study of childhood attendance at emergency departments in the West Midlands region. Emerg Med J 2006;23(5):391-393.
18. Kennedy RM, Luhmann JD, Luhmann SJ. Emergency department management of pain and anxiety related to orthopedic fracture care. Pediatr Drugs 2004;6(1):11-31.
19. Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res 2004;19(12):1976-1981.
20. de Inocencio J, Carro MÁ, Flores M, Carpio C, Mesa S, Marín M. Epidemiology of musculoskeletal pain in a pediatric emergency department. Rheumatol Int 2016;36(1):83-89.
21. Merkel S, Voepel-Lewis T, Malviya S. Pain Assessment in Infants and Young Children: The FLACC Scale: A behavioral tool to measure pain in young children. AJN Am J Nurs 2002;102(10):55-58.
22. Manworren RC, Hynan LS. Clinical validation of FLACC: preverbal patient pain scale. Pediatr Nurs 2003;29(2):140.
23. Kochman A, Howell J, Sheridan M, Kou M, Ryan EES, Lee S, et al. Reliability of the faces, legs, activity, cry, and consolability scale in assessing acute pain in the pediatric emergency department. Pediatr Emerg Care 2017;33(1):14-17.
24. Wong-Baker FACES foundation. Wong-Baker FACES Pain Rating Scale. Avaiable at https://wongbakerfaces.org/. Accessed in August 27, 2020.
25. McCaffery M, Beebe A, others. Pain: Clinical manual for nursing practice, Mosby St. Louis Mo. 1989;
26. Drendel AL, Kelly BT, Ali S. Pain assessment for children: overcoming challenges and optimizing care. Pediatr Emerg Care 2011;27(8):773-781.
27. Freund D, Bolick BN. CE: Assessing a Child’s Pain. AJN Am J Nurs 2019;119(5):34-41.
28. Abouzida S, Bourgault P, Lafrenaye S. Observation of Emergency Room Nurses Managing Pediatric Pain: Care to Be Given… Care Given…. Pain Manag Nurs. 2020; Volume publish ahead of print. Available at: http://www.sciencedirect.com/science/article/pii/S1524904220301077
29. Thomas D, Kircher J, Plint AC, Fitzpatrick E, Newton AS, Rosychuk RJ, et al. Pediatric pain management in the emergency department: the triage nurses’ perspective. J Emerg Nurs 2015;41(5):407-413.
30. Benini F, Castagno E, Urbino A, Fossali E, Mancusi R, Milani G. Pain management in children has significantly improved in the Italian emergency departments. Acta Paediatr 2020;109(7):1445-1449.
31. Guiner A, Street MH, Oke O, Young VB, Hennes H. Pain Reduction Emergency Protocol: A Prospective Study Evaluating Impact of a Nurse-initiated Protocol on Pain Management and Parental Satisfaction. Pediatr Emerg Care 2020 Volume Publish Ahead of Print-Issue-doi: 10.1097/PEC.0000000000002193.