Acute Pain in Pediatric Emergency Settings: Challenges and Solutions

Introduction: Today, pain is characterized not only as physiological reaction and response to tissue damage, it is recognized as multidisciplinary issue and multi-profile problem. Over the last decades great progress was made in pediatric pain evaluation and pain management. Unfortunately, acute pediatric pain still remains misunderstood, under-diagnosed, and under-treated.

Aims: To investigate accuracy of acute pain assessment and management in Pediatric Emergency Department (PED) in Lithuania University of Health Sciences Hospital Kauno Klinikos (LSMU KK).

Methods: We performed a retrospective card record analysis before (year 2017) and after (year 2018) pediatric pain training course was conducted. In total, 1000 randomly selected outpatient card records were analyzed. All cases were divided into two groups: group A records from 2017, group B – from 2018. Cases were further divided into trauma and non-trauma and subdivided into 4 different age groups. We collected patient age, origin of pain, pain characteristics, pain score and medication.

Results: We compared 500 pain cases in each group. Group A and B consisted of 154 (30.8%) and 116 (23.2%) traumatic patients respectively. Pain was scored less in group A (420 children (84%)) comparing to group B (94.4% of all 500 cases, p<0.001). In all age groups of group B pain was assessed more frequently and pain medication was prescribed more often compared to group A (p <0.001). There was a tendency to assess pain more often in non-traumatic patients in group A (p=0.054). However, pain relief in traumatic patients was less adequate compared to non-traumatic.

Conclusion: Pain evaluation differed in both groups. In group B pain was evaluated more frequently and received pain-medication more often than group A. Teenagers are still less likely to receive analgesics than toddlers. Tendency remains to give less painkillers to trauma patients compared to non-traumatic children.