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Özdemir G, Küçük Alemdar D. Turkish validity and reliability study of the Alder hey child triage pain scale. J Pediatr Nurs 2024:S0882-5963(24)00195-7. [PMID: 38762426 DOI: 10.1016/j.pedn.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
AIM This study was performed to examine the Turkish validity and reliability of the Alder Hey Triage Pain Scale (AHTPS) for children aged 3-15 years who attended the pediatric emergency service with a complaint of pain. MATERIAL AND METHOD The sample for the methodological research was composed of 300 children between the ages of 3 and 15 who attended the University Training and Research Hospital Pediatric Emergency Clinic with a complaint of pain. Data were collected by using the Child and Parent Descriptive Information Form, Emergency Service Patient Triage, Treatment and Observation Form, AHTPS, and Wong-Baker Faces Pain Scale (WBFPS). RESULTS Of the children participating in the study, 54.3% were female and 30.7% were between the ages of 12-15. The total content validity index score of the AHTPS was determined as 0.99 and the content validity rate score was 0.98. The interobserver concordance of AHTPS was examined and the concordance of two observers was significant and very good (p < 0.001). For the concordance of scale with similar scales, the WBFPS was used and during the 1st and 2nd measurements, intra-observer reliability of AHTPS was statistically significant and very good (p < 0.001). Cronbach alpha values of the scale were in the range of 0.619 and 0.679 and the scale was reliable. CONCLUSIONS As a result, the adaptation of the AHTPS to Turkish is a valid and reliable measurement tool. PRACTICE IMPLICATIONS Pain assessment for children attending the emergency service should be performed more systematically with scales like the AHTPS.
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Affiliation(s)
- Gamze Özdemir
- Ministry of Health Ordu State Hospital, Department of General Surgery, Ordu, Turkey
| | - Dilek Küçük Alemdar
- Ordu University Faculty of Health Sciences, Department of Nursing, Ordu, Turkey.
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Rybojad B, Sieniawski D, Rybojad P, Samardakiewicz M, Aftyka A. Pain Evaluation in the Paediatric Emergency Department: Differences in Ratings by Patients, Parents and Nurses. Int J Environ Res Public Health 2022; 19:2489. [PMID: 35206676 DOI: 10.3390/ijerph19042489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022]
Abstract
The pain experienced by paediatric patients is rarely evaluated in emergency departments. The aim of the present study was to compare the degree of conformity in patients’ pain severity when assessed by themselves (if possible), their parents and a triage nurse trained in pain evaluation. Methods: A cross-sectional observational study was conducted at a tertiary paediatric emergency department in Eastern Poland involving children (aged six months to eighteen years), their parents and nurses. The patients had their pain assessed while collecting a medical history. For children ≥ four years of age, the Numerical Rate Scale was used by patients, parents and nurses to evaluate pain. Patients under four years of age were evaluated by parents and nurses using the FLACC scale. Results: Eighty patients and their parents were enrolled in the study. For children ≥ four years, patients rated their pain significantly higher than both their parents (p = 0.03) and nurses (p < 0.001), with the latter group producing the lowest scores. For children under four years of age, parental pain assessments did not significantly differ from those of nurses. Conclusion: Compared to the patients themselves and their parents, nurses tended to assign lower pain scores for children. Pain should be assessed on admission to the ED and, whenever possible, by the patients themselves.
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Davis S, Ju C, Marchandise P, Diagne M, Grant L. Impact of Pain Assessment on Canadian Triage and Acuity Scale Prediction of Patient Outcomes. Ann Emerg Med 2022; 79:433-440. [DOI: 10.1016/j.annemergmed.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/27/2021] [Accepted: 01/03/2022] [Indexed: 11/01/2022]
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Farahmand B, Pourhosaingholi E, Bagheri A. Investigating the effects of volar wrist cock-up splint and dorsal lock wrist hand orthosis in reducing signs of carpal tunnel syndrome. Med J Islam Repub Iran 2021; 35:53. [PMID: 34268241 PMCID: PMC8271271 DOI: 10.47176/mjiri.35.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy presenting with sharp pain, parenthesis, dysfunction of the hand in coordination and gripping. Splinting is the most common conservative intervention to improve pain and enological symptom of this Syndrome (CTS). With regard to the importance of these interventions and controversies about different designs of splints, the aim of this study was to compare the therapeutic effects of volar wrist cock-up orthosis and dorsal lock wrist hand orthosis on pain, sensory and motor latency in carpal tunnel syndrome. Methods: In this Randomized controlled trial study, 30 patients diagnosed with mild to moderate CTS were recruited. The subjects were randomly divided into two equal groups. Both groups received one form of splints for three weeks. Before receiving the splints, Electromyography (EMG) and Visual analog scale (VAS) were performed. Then, two different designs of splints were used for a period of three weeks. After that, EMG and Numerical Rating Scale (NRS-11) were repeated to reveal the effects of splints on reducing pain, sensory and motor latency in CTS. Independent t and paired t-tests were done uding SPSS software version 19.0. P-value was set at 0.05. Results: All the variables in both groups showed significant improvement. The NRS-11 test was significantly improved in the dorsal lock wrist hand orthosis group (p<0.05). Conclusion: This study showed that the use of the dorsal lock wrist hand orthosis for about three weeks was significantly improved pain and neurological symptoms of patients with CTS because of maintaining the wrist in the neutral position. Knowing this fact helps us to design and make a less cumbersome and restrictive splint with an accurate position for the wrist and distal joints.
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Affiliation(s)
- Behshid Farahmand
- Department of Orthotics & Prosthetics, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Ensieh Pourhosaingholi
- Department of Orthotics & Prosthetics, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Bagheri
- Department of Orthotics & Prosthetics, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
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Tripanpitak K, Viriyavit W, Huang SY, Yu W. Classification of Pain Event Related Potential for Evaluation of Pain Perception Induced by Electrical Stimulation. Sensors (Basel) 2020; 20:E1491. [PMID: 32182766 PMCID: PMC7085779 DOI: 10.3390/s20051491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 12/30/2019] [Accepted: 01/04/2020] [Indexed: 12/11/2022]
Abstract
Variability in individual pain sensitivity is a major problem in pain assessment. There have been studies reported using pain-event related potential (pain-ERP) for evaluating pain perception. However, none of them has achieved high accuracy in estimating multiple pain perception levels. A major reason lies in the lack of investigation of feature extraction. The goal of this study is to assess four different pain perception levels through classification of pain-ERP, elicited by transcutaneous electrical stimulation on healthy subjects. Nonlinear methods: Higuchi's fractal dimension, Grassberger-Procaccia correlation dimension, with auto-correlation, and moving variance functions were introduced into the feature extraction. Fisher score was used to select the most discriminative channels and features. As a result, the correlation dimension with a moving variance without channel selection achieved the best accuracies of 100% for both the two-level and the three-level classification but degraded to 75% for the four-level classification. The best combined feature group is the variance-based one, which achieved accuracy of 87.5% and 100% for the four-level and three-level classification, respectively. Moreover, the features extracted from less than 20 trials could not achieve sensible accuracy, which makes it difficult for an instantaneous pain perception levels evaluation. These results show strong evidence on the possibility of objective pain assessment using nonlinear feature-based classification of pain-ERP.
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Affiliation(s)
- Kornkanok Tripanpitak
- Department of Medical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan; (K.T.); (W.V.)
| | - Waranrach Viriyavit
- Department of Medical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan; (K.T.); (W.V.)
- School of ICT, Sirindhorn International Institute of Technology, Thammasat University, Pathum Thani 12120, Thailand
| | - Shao Ying Huang
- Engineering Product Design, Singapore University of Technology and Design, 8 Somapah Road, Singapore 487372, Singapore;
| | - Wenwei Yu
- Department of Medical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan; (K.T.); (W.V.)
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
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Giordano V, Edobor J, Deindl P, Wildner B, Goeral K, Steinbauer P, Werther T, Berger A, Olischar M. Pain and Sedation Scales for Neonatal and Pediatric Patients in a Preverbal Stage of Development: A Systematic Review. JAMA Pediatr 2019; 173:1186-1197. [PMID: 31609437 DOI: 10.1001/jamapediatrics.2019.3351] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
IMPORTANCE Because children in a preverbal stage of development are unable to voice their feelings, they completely depend on their caregiving team for the interpretation and management of their pain and discomfort. Thus, accurately validated scales to assess pain and sedation levels are crucial. OBJECTIVE To provide clinicians a complete overview on the validity and reliability of the existing pain and sedation scales for different target populations (preterm infants, term infants, and toddlers) and in different clinical contexts. EVIDENCE REVIEW BIOSIS Previews, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycCRITIQUES, PsycINFO, PSYNDEXplus Literature and Audiovisual Media, and PSYNDEXplus Tests were the databases screened from their inception to August 2018. All studies examining the validity or reliability of a given pain or sedation scale for patients in a preverbal stage of development were included in this systematic review. Those scales that were tested for at least construct validity, internal consistency, and interrater reliability were subsequently scored using the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist. FINDINGS In total, 89 validation articles comprising 65 scales were included. Fifty-seven scales (88%) were useful for assessing pain, 13 scales (20%) for assessing sedation, and 4 scales (6%) for assessing both conditions. Forty-two (65%) were behavioral scales, and 23 (35%) were multidimensional scales. Eleven scales (17%) were validated for infants on mechanical ventilation. Thirty-seven scales (57%) were validated for preterm infants, 24 scales (37%) for term and preterm infants, 7 scales (11%) for term-born children, 7 scales (11%) for preterm infants, term infants, and toddlers, and 17 scales (26%) for term infants and toddlers. Twenty-eight scales (43%) considered construct validity, internal consistency, and interrater reliability. CONCLUSIONS AND RELEVANCE Clinicians should consider using scales that are validated for at least construct validity, internal consistency, and interrater reliability, combining this information with the population of interest and the construct the scale is intended to measure.
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Affiliation(s)
- Vito Giordano
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Joy Edobor
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Germany
| | - Brigitte Wildner
- Information Retrieval Office, University Library of the Medical University of Vienna, Vienna, Austria
| | - Katharina Goeral
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Tobias Werther
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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van der Heijden MJE, Mevius H, van der Heijde N, van Rosmalen J, van As S, van Dijk M. Children Listening to Music or Watching Cartoons During ER Procedures: A RCT. J Pediatr Psychol 2019; 44:1151-1162. [PMID: 31621845 DOI: 10.1093/jpepsy/jsz066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aims to determine if listening to music and watching cartoons are effective to distract children from pain and distress during procedures in the emergency room (ER). METHODS This study is a single-center, 3-armed, superiority randomized controlled trial comparing listening to music, watching cartoons, and standard care during ER procedures in children aged 3-13 years. The primary outcome was pain measured from video footage with the Alder Hey Triage Pain Score (AHTPS). Children older than 4 years self-reported pain with the Faces Pain Scale-Revised (FPS-R). The secondary outcome was distress measured with the Observational Scale of Behavioral Distress-revised (OSBD-r). Another indicator of distress was heart rate. RESULTS Data of 191 participants were analyzed for the 3 groups: music (n = 75), cartoon (n = 62), and control (n = 54). The median age was 7.3 years (4.9-9.7). In multivariable analysis, pain assessed with the AHTPS was significantly lower (B = -1.173, 95% confidence interval -1.953, -0.394, p = .003) in the music group than in the control groups. Across the 3 groups, 108 children self-reported pain with the FPS-R after the procedure. The scores were lowest in the music group, but the differences between groups were not significant (p = .077). OSBD-r distress scores assigned during the procedures were not significantly different between the 3 groups (p = .55). Heart rate directly after the procedure was not statistically significantly different between the 3 groups (p = .83). CONCLUSIONS Listening to recorded music is a beneficial distraction for children experiencing pain during ER procedures, whereas watching cartoons did not seem to reduce pain or distress.
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Affiliation(s)
- Marianne J E van der Heijden
- Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital.,Department of Internal Medicine, Erasmus MC, Sophia Children's Hospital
| | - Hiske Mevius
- Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital
| | | | | | | | - Monique van Dijk
- Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital.,Department of Pediatric Surgery, Red Cross Children's Hospital
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Abstract
Nearly 20 years ago, standards were established for hospitals to assess and treat pain in all patients. Research continues to demonstrate evolving trends in the measurement and effective treatment of pain in children. Behavioral research demonstrating long-lasting effects of inadequate pain control during childhood supports the concepts of early and adequate pain control for children suffering from painful conditions in the acute care setting. The authors discuss pain concepts, highlighting factors specific to the emergency department, and include a review of evidence for pharmacologic and nonpharmacologic treatments.
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Montaud Q, Lanoux T, Watremez M, Fontaine X. Évaluation et prise en charge de la douleur d’origine traumatique chez l’enfant de moins de quinze ans aux urgences. Ann Fr Med Urgence 2017. [DOI: 10.1007/s13341-017-0784-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Abstract
Objective The progressive rise in demand on NHS emergency care resources is partly attributable to increases in attendances of children and older people. A quality gap exists in the care provision for the old and the young. The Five Year Forward View suggested new models of care but that the "answer is not one-size-fits-all". This article discusses the urgent need for person-centred outcome measures to bridge the gap that exists between demand and provision. Design This review is based on evidence gathered from literature searching across several platforms using a variety of search terms to account for the obvious heterogeneity, drawing on key 'think-tank' evidence. Settings Qualitative and quantitative studies examining approaches to caring for individuals at the extremes of age. Participants Individuals at the extremes of age (infants and older people). Main Outcome Measures Understanding similarities and disparities in the care of individuals at the extremes of age in an emergency and non-emergency context. Results There exists several similarities and disparities in the care of individuals at the extremes of age. The increasing burden of health disease on the economy must acknowledge the challenges that exist in managing patients in emergency settings at the extremes of age and build systems to acknowledge the traits these individuals exhibit. Conclusion Commissioners of services must optimise the models of care delivery by appreciating the similarities and differences between care requirements in these two large groups seeking emergency care.
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Affiliation(s)
- J S Minhas
- 1 Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK
| | - D Minhas
- 2 Department of Paediatrics, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - T Coats
- 3 Emergency Medicine Academic Group, Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW, UK
| | - J Banerjee
- 3 Emergency Medicine Academic Group, Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW, UK
| | - D Roland
- 4 Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester LE1 7RH, UK.,5 Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester LE1 5WW, UK
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James F, Edwards R, James N, Dyer R, Goodwin V. The Royal College of Emergency Medicine composite pain scale for children: level of inter-rater agreement. Emerg Med J 2017; 34:360-363. [DOI: 10.1136/emermed-2015-205517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 07/25/2016] [Accepted: 02/02/2017] [Indexed: 11/03/2022]
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Sekhon KK, Fashler SR, Versloot J, Lee S, Craig KD. Children's Behavioral Pain Cues: Implicit Automaticity and Control Dimensions in Observational Measures. Pain Res Manag 2017; 2017:3017837. [PMID: 28321174 DOI: 10.1155/2017/3017837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 12/16/2016] [Accepted: 01/24/2017] [Indexed: 11/17/2022]
Abstract
Some pain behaviors appear to be automatic, reflexive manifestations of pain, whereas others present as voluntarily controlled. This project examined whether this distinction would characterize pain cues used in observational pain measures for children aged 4-12. To develop a comprehensive list of cues, a systematic literature search of studies describing development of children's observational pain assessment tools was conducted using MEDLINE, PsycINFO, and Web of Science. Twenty-one articles satisfied the criteria. A total of 66 nonredundant pain behavior items were identified. To determine whether items would be perceived as automatic or controlled, 277 research participants rated each on multiple scales associated with the distinction. Factor analyses yielded three major factors: the "Automatic" factor included items related to facial expression, paralinguistics, and consolability; the "Controlled" factor included items related to intentional movements, verbalizations, and social actions; and the "Ambiguous" factor included items related to voluntary facial expressions. Pain behaviors in observational pain scales for children can be characterized as automatic, controlled, and ambiguous, supporting a dual-processing, neuroregulatory model of pain expression. These dimensions would be expected to influence judgments of the nature and severity of pain being experienced and the extent to which the child is attempting to control the social environment.
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Abstract
The authors present a review of the pathophysiology of pneumothoraces, the indications and the procedures required for the insertion of chest drains, and review paediatric practice using the recently developed Seldinger-style percutaneous chest drains.
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Affiliation(s)
- PM Parslow
- Poole Hospital NHS Trust, Poole, Dorset, UK
| | - JM Sandell
- Poole Hospital NHS Trust, Poole, Dorset, UK,
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Abstract
Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.
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Affiliation(s)
- Benoit Bailey
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
| | - Evelyne D Trottier
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
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van Miert C, Abbott J, Verheoff F, Lane S, Carter B, McNamara P. Development and validation of the Liverpool infant bronchiolitis severity score: a research protocol. J Adv Nurs 2014; 70:2353-62. [PMID: 24673581 DOI: 10.1111/jan.12387] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2014] [Indexed: 11/30/2022]
Abstract
AIM To develop and validate a bronchiolitis severity scoring instrument for use by nurses and other healthcare professions. BACKGROUND Bronchiolitis is a viral lower respiratory tract infection of infancy. In industrialized countries, admission rates have increased over the last decade with up to 3% of all infants born being admitted to hospital. A small number of these hospitalized infants will require admission to critical care for either invasive or non-invasive ventilation. During the seasonal epidemic, the number of unplanned admissions to critical care with bronchiolitis substantially increases. DESIGN We will use a mixed methods study design. METHODS We will use scale development and psychometric methods to develop a scoring instrument and to test the instrument for content, construct and criterion validity and reliability in several different clinical locations. This study protocol has been reviewed and approved by the NHS National Research Ethics Service, January 2011. DISCUSSION There is an urgent need to develop a valid and reliable severity scoring instrument sensitive to clinical changes in the infant, to facilitate clinical decision-making and help standardize patient care. Furthermore, a valid and reliable scoring instrument could also be used as a proxy patient-reported outcome measure to evaluate the efficacy of clinical interventions in randomized controlled trials.
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Affiliation(s)
- Clare van Miert
- R&D, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Farmer E, Chase-Topping M, Lawson H, Clutton RE. Factors affecting the perception of recovery quality in horses after anaesthesia. Equine Vet J 2013; 46:328-32. [PMID: 23819890 DOI: 10.1111/evj.12133] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 06/24/2013] [Indexed: 12/01/2022]
Abstract
REASONS FOR PERFORMING STUDY A significant effect of gender, experience and background, i.e. an evaluator's relationship with horses as equine anaesthetists, orthopaedic surgeons, practitioners or owners, on perceptions of recovery quality after anaesthesia would reduce the validity of recovery quality scoring systems. OBJECTIVES To determine the effects of evaluator background, experience and gender on their perceptions of recovery quality; and questionnaire response rate as a function of background. STUDY DESIGN Cross-sectional survey. METHODS A total of 440 potential evaluators were invited to evaluate the video-recorded recoveries of 24 horses using a visual analogue scale (VAS) in which 0 = worst, 100 = best possible recovery. A mean score was generated for each of the 1-24 recoveries within each background group. These were compared using Spearman's rank correlation. The effect of gender and experience on VAS scores were analysed using an ordinal logistic regression after scores were categorised into 'intermediate, 'worst' and 'best' recovery categories based on median, 25th and 75th percentile VAS scores, respectively. RESULTS The overall response rate was 35%. The greatest was from the anaesthetists (78%) followed by surgeons (43%). The response rate among owners and practitioners was 26%. Correlation among VAS scores across all background groups was high (Spearman rank > 0.90; P < 0.001). Among the combined veterinarians, there was no significant gender (P = 0.551) or experience (P = 0.103) effect. Among horse owners, the effect of experience was not significant (P = 0.116) although gender was (P = 0.027). Male horse owners awarded significantly greater scores than females. CONCLUSIONS When VAS are used to grade recovery quality, neither the background nor the gender of veterinary evaluators affects quality perception. Male owners awarded greater scores than female owners, implying that they are less critical of recovery quality and a gender effect among horse owners must be considered when VAS are used to score recovery quality.
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Affiliation(s)
- E Farmer
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, UK
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Liu H, Fan YF, Wei MX. Progress in understanding association between microRNAs and gastric cancer. Shijie Huaren Xiaohua Zazhi 2013; 21:2289-2293. [DOI: 10.11569/wcjd.v21.i23.2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
MicroRNAs (miRNAs) are a class of highly conservative small non-coding RNA molecules, about 16-29 nt in length. Being expressed in a temporal- and tissue-specific manner, miRNAs can be involved in gene expression and regulation and are important in regulating cell proliferation, differentiation and apoptosis. Since miRNAs are significantly differentially expressed between normal tissues and tumor tissues, they play an important role in the process of tumor development. This paper reviews the progress in understanding the association between miRNAs and gastric cancer.
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Abstract
Injury is the leading cause of death and disability in children. Each year, almost one in six children in the United States require emergency department (ED) care for the treatment of injuries, and more than 10,000 children die from injuries. Severely injured children need to be transported to a facility that is staffed 24/7 by personnel experienced in the management of children, and that has all the appropriate equipment to diagnose and manage injuries in children. Anatomical, physiological, and emotional differences between adults and children mean that children are not just scaled-down adults. Facilities receiving injured children need to be child and family friendly, in order to minimize the psychological impact of injury on the child and their family/carers. Early recognition and treatment of life-threatening airway obstruction, inadequate breathing, and intra-abdominal and intra-cranial hemorrhage significantly increases survival rate after major trauma. The initial assessment and management of the injured child follows the same ATLS® sequence as adults: primary survey and resuscitation, followed by secondary survey. A well-organized trauma team has a leader who designates roles to team members and facilitates clear, unambiguous communication between team members. The team leader stands where he/she can observe the entire team and monitor the “bigger picture.” Working together as a cohesive team, the members perform the primary survey in just a few minutes. Life-threatening conditions are dealt with as soon as they are identified. Necessary imaging studies are obtained early. Constant reassessment ensures that any deterioration in the child's condition is picked up immediately. The secondary survey identifies other injuries, such as intra-abdominal injuries and long-bone fractures, which can result in significant hemorrhage. The relief of pain is an important part of the treatment of an injured child.
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Affiliation(s)
- J Grant McFadyen
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Scott LE, Crilly J, Chaboyer W, Jessup M. Paediatric pain assessment and management in the emergency setting: the impact of a paediatric pain bundle. Int Emerg Nurs 2012; 21:173-9. [PMID: 23010611 DOI: 10.1016/j.ienj.2012.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/13/2012] [Accepted: 08/13/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the impact of a paediatric pain bundle on pain assessment and management of children with fractured forearms who presented to an Emergency Department (ED). METHODS A descriptive, comparative pilot study was conducted at a large regional hospital ED to describe differences in pain assessment, management and documentation in the 4months before and after the implementation of a paediatric pain bundle. RESULTS A total of 242 children with fractured forearms visited the ED over two separate 4-month periods during 2009. Compared to the pre time period, children in the post time period did not differ significantly regarding pain assessment score documentation (13.5% vs. 20.7%, p=0.14), administration rate of analgesia (58.7% vs. 65.5%, p=0.28) or time to analgesia (28min vs. 35min, p=0.22). CONCLUSIONS In this pilot study, findings indicated clinical significance but not statistical significance. The assessment and management of pain in the ED paediatric population is challenging due to difficulties interpreting responsiveness and to organisational and system imperatives that delay time critical aspects such as time to analgesia. Further focus on documentation, assessment and management practices is required in larger populations across a number of sites.
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Affiliation(s)
- Lucie E Scott
- Emergency Department, Gold Coast Hospital, Queensland Health, Australia.
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Fournier-Charrière E, Tourniaire B, Carbajal R, Cimerman P, Lassauge F, Ricard C, Reiter F, Turquin P, Lombart B, Letierce A, Falissard B. EVENDOL, a new behavioral pain scale for children ages 0 to 7 years in the emergency department: Design and validation. Pain 2012; 153:1573-1582. [DOI: 10.1016/j.pain.2012.02.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 01/09/2012] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
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Williams S, Holzhauser K, Bonney D, Burmeister E, Gilhotra Y, Oliver R, Gordon K. Improving pain management of abdominal pain in children presenting to the paediatric emergency department: a pre-post interventional study. ACTA ACUST UNITED AC 2012; 15:133-47. [PMID: 22947686 DOI: 10.1016/j.aenj.2012.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 04/18/2012] [Accepted: 04/18/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND In 2007, the Mater Children's Hospital Emergency Department participated in the Emergency Care Pain Management Initiative funded by the National Health and Medical Research Council National Institute of Clinical Studies (NHMRC-NICS). The findings of this NHMRC-NICS research across eleven paediatric emergency departments highlighted deficits in pain management of abdominal pain. Specifically pain assessment, timeliness of analgesia, and pain management guidelines were found to be lacking. METHODS In response to the NICS report local practice was reviewed and a pilot research project undertaken to develop a clinical guideline for the pain management of abdominal pain in children presenting to the emergency department. The guideline was developed by an expert panel and trialled using a pre and post intervention design. RESULTS The results demonstrated improved compliance to assessment and documentation of pain scores and assimilation of the best practice principles recommended in the guideline. CONCLUSIONS This project raised local awareness in the pain management of abdominal pain and provides baseline information for future improvement. The guideline has been trialled in the clinical setting of paediatric emergency and has the potential to improve pain management practices in children presenting to the emergency department with abdominal pain.
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Affiliation(s)
- Suzanne Williams
- Mater Children's Hospital, Emergency Department, Brisbane, Australia.
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23
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Abstract
MicroRNAs (miRNAs) are a new class of highly conserved non-coding small endogenous RNAs. Owing to a high degree of evolutionary conservation and temporal and tissue-specific expression patterns, they participate in the regulation of gene expression and play a pivotal role in the pathogenesis of gastric cancer. In this article, we will focus on the role of miRNAs in gastric carcinogenesis.
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Abstract
AIM Detecting children's pain in a healthcare setting can be improved by facilitating pain expression in ways that are appropriate to the child's cognitive development and that can be recognised by their carers. To ensure up-to-date guidance on assessing pain in children, the Royal College of Nursing undertook an evidence-based update of pain assessment guidelines, initially published in 2000. METHODS Following systematic review of the psychometric testing literature, a two-stage critical appraisal process was developed to derive a list of robust tools that could be recommended for use in a variety of settings to assess the intensity of a child's acute pain. Studies were appraised on the basis of their relevance to this topic and according to prespecified quality criteria. Tools were assessed for inclusion in guideline recommendations according to minimum validity and reliability thresholds. RESULTS Overall the quality of literature was poor, limited by small samples, lack of control groups, unblinded raters and convenience sampling. Twenty-four tools are recommended for use with infants and verbal children without cognitive impairment, 11 of which are purely self-report tools. Eight tools are recommended for use with neonates, some of which require concurrent physiological measures. Four tools are considered valid for use in children with cognitive impairment. All of these tools had shown reliability and validity according to the criteria established for this review. CONCLUSION The tools are presented in user-friendly tables that include a guide to their key features and the setting and age groups in which they have been validated. They are accompanied by good practice recommendations from experts and recommendations relating to timing and triggers for pain assessment. These outputs are some of those associated with the full guidelines and supporting material published on the Royal College of Nursing website (http://www.rcn.org.uk/childrenspainguideline).
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Abstract
CONTEXT Numerous faces scales have been developed for the measurement of pain intensity in children. It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity, reliability, feasibility, and preference. OBJECTIVES To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility. METHODS Five major electronic databases were systematically searched for studies that used a faces scale for the self-report measurement of pain intensity in children. Fourteen faces pain scales were identified, of which 4 have undergone extensive psychometric testing: Faces Pain Scale (FPS) (scored 0-6); Faces Pain Scale-Revised (FPS-R) (0-10); Oucher pain scale (0-10); and Wong-Baker Faces Pain Rating Scale (WBFPRS) (0-10). These 4 scales were included in the review. Studies were classified by using psychometric criteria, including construct validity, reliability, and responsiveness, that were established a priori. RESULTS From a total of 276 articles retrieved, 182 were screened for psychometric evaluation, and 127 were included. All 4 faces pain scales were found to be adequately supported by psychometric data. When given a choice between faces scales, children preferred the WBFPRS. Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS. CONCLUSIONS For clinical use, we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use. For research use, the FPS-R has been recommended on the basis of utility and psychometric features. Data are sparse for children below the age of 5 years, and future research should focus on simplified measures, instructions, and anchors for these younger children.
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Affiliation(s)
- Deborah Tomlinson
- Child Health Evaluative Services, Hospital for Sick Children, Toronto, Ontario, Canada.
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Crellin D, Sullivan TP, Babl FE, O'Sullivan R, Hutchinson A. Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting. Paediatr Anaesth 2007; 17:720-33. [PMID: 17596217 DOI: 10.1111/j.1460-9592.2007.02218.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Assessing procedural pain and distress in young children is difficult. A number of behavior-based pain and distress scales exist which can be used in preverbal and early-verbal children, and these are validated in particular settings and to variable degrees. METHODS We identified validated preverbal and early-verbal behavioral pain and distress scales and critically analysed the validation and reliability testing of these scales as well as their use in procedural pain and distress research. We analysed in detail six behavioral pain and distress scales: Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), Faces Legs Activity Cry Consolability Pain Scale (FLACC), Toddler Preschooler Postoperative Pain Scale (TPPPS), Preverbal Early Verbal Pediatric Pain Scale (PEPPS), the observer Visual Analog Scale (VASobs) and the Observation Scale of Behavioral Distress (OSBD). RESULTS Despite their use in procedural pain studies none of the behavioral pain scales reviewed had been adequately validated in the procedural setting and validation of the single distress scale was limited. CONCLUSIONS There is a need to validate behavioral pain and distress scales for procedural use in preverbal or early-verbal children.
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Affiliation(s)
- Dianne Crellin
- Department of Emergency, Royal Children's Hospital, Melbourne, Victoria, Australia
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Judd O, Garise F. Double-blind randomised controlled study of coblation tonsillotomy versus coblation tonsillectomy on postoperative pain in children. Clin Otolaryngol 2007; 31:456; author reply 457. [PMID: 17014462 DOI: 10.1111/j.1749-4486.2006.01251.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The treatment of acute pain and anxiety in children undergoing therapeutic and diagnostic procedures in the emergency department has improved dramatically over the last few years. The availability of noninvasive monitoring devices and the use of short-acting sedative and analgesic medications enable physicians to conduct safe and effective sedation and analgesia treatment. In today's practice of pediatric emergency medicine, sedation and analgesia has been considered as the standard of care for procedural pain. The following article describes the basic principles of pediatric procedural sedation and analgesia in the emergency department.
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Affiliation(s)
- Itai Shavit
- Department of Pediatric Emergency, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel.
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Knutsson J, Tibbelin A, Von Unge M. Postoperative pain after paediatric adenoidectomy and differences between the pain scores made by the recovery room staff, the parent and the child. Acta Otolaryngol 2006; 126:1079-83. [PMID: 16923714 DOI: 10.1080/00016480600606715] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSIONS The parents scored the postoperative pain higher than the nurse. The nurse's score correlated better than the parent's to the child's score. There was no gender difference regarding the pain after adenoidectomy. OBJECTIVE To evaluate the correlation between the parents and the health care professionals regarding how postoperative pain is estimated and to identify age and gender differences regarding the pain after adenoidectomy. PATIENTS AND METHODS The study included 100 children aged 3-10 years scheduled for adenoidectomy. The nurse and the parent assessed the postoperative pain of the child at different time intervals using a visual analogue scale (VAS). The child rated its pain by using the Wong-Baker FACES pain rating scale. RESULTS The postoperative pain scores were higher at 10 min after the operation than after 30 min. The parents scored the pain higher than the nurse did, but there was still a strong correlation between the observers' rating of the pain. The correlation between the nurse's and the child's assessments was stronger than the correlation between the parent's and the child's assessments. There was no gender difference in how the pain was perceived by the child. The parents tended to score the pain higher with older age of the child.
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Affiliation(s)
- Johan Knutsson
- Department of Otorhinolaryngology, Västerås Central Hospital, Sweden.
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von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain 2006; 127:140-50. [PMID: 16996689 DOI: 10.1016/j.pain.2006.08.014] [Citation(s) in RCA: 422] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 07/15/2006] [Accepted: 08/11/2006] [Indexed: 01/17/2023]
Abstract
Observational (behavioral) scales of pain for children aged 3 to 18 years were systematically reviewed to identify those recommended as outcome measures in clinical trials. This review was commissioned by the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (www.immpact.org). In an extensive literature search, 20 observational pain scales were identified for review including behavior checklists, behavior rating scales, and global rating scales. These scales varied in their reliance on time sampling and inclusion of physiological items, facial and postural items, as well as their inclusion of multiple dimensions of assessment (e.g., pain and distress). Each measure was evaluated based on its reported psychometric properties and clinical utility. Scales were judged to be indicated for use in specific acute pain contexts rather than for general use. Two scales were recommended for assessing pain intensity associated with medical procedures and other brief painful events. Two scales were recommended for post-operative pain assessment, one for use in hospital and the other at home. Another scale was recommended for use in critical care. Finally, two scales were recommended for assessing pain-related distress or fear. No observational measures were recommended for assessing chronic or recurrent pain because the overt behavioral signs of chronic pain tend to habituate or dissipate as time passes, making them difficult to observe reliably. In conclusion, no single observational measure is broadly recommended for pain assessment across all contexts. Directions for further research and scale development are offered.
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Affiliation(s)
- Carl L von Baeyer
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada S7N 5A5.
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Knutsson J, Tibbelin A, Von Unge M. Adjuvant local anaesthetics in the epipharyngeal space in day-case adenoidectomy: a prospective, randomized, double-blind, placebo-controlled trial. Acta Otolaryngol 2006; 126:51-5. [PMID: 16308255 DOI: 10.1080/00016480510043459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSION Mepivacaine applied in the epipharyngeal space as an adjuvant local anaesthetic does not reduce postoperative pain after adenoidectomy in children given high-dose paracetamol preoperatively. OBJECTIVE To evaluate the pain-reducing effect of an adjuvant local anaesthetic (mepivacaine) applied in the epipharyngeal space after outpatient adenoidectomy. MATERIAL AND METHODS This was a prospective, randomized, double-blind, placebo-controlled trial. Postoperative pain was assessed in 98 children aged 3-10 years using a visual analogue scale (VAS) and the Wong-Baker FACES pain rating scale. The time between the end of surgery and discharge from hospital was recorded, as well as the need for extra pain medication in addition to the high-dose paracetamol (acetaminophen) that had been given preoperatively. Serum levels of mepivacaine were analysed in 10 consecutive patients. RESULTS No difference was seen between the mepivacaine and control groups regarding postoperative pain as estimated using either the VAS or the Wong-Baker FACES pain rating scale. There were also no differences between the groups concerning the time to discharge from hospital and the need for extra pain medication before discharge. No mepivacaine could be detected in the patients' sera.
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Affiliation(s)
- Johan Knutsson
- Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden.
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