Original Article
Pain Prevalence, Intensity, Assessment and Management in a Hospitalized Pediatric Population

Preliminary results presented as a poster at: the American Society for Pain Management Nursing 18th national conference, October 3-6, 2008; the National Association of Pediatric Nurse Practitioners 30th annual conference on pediatric health care, March 19-22, 2009; and the American Society of Anesthesiologists 2009 annual meeting, October 17-21, 2009.
https://doi.org/10.1016/j.pmn.2012.04.003Get rights and content

Abstract

New research, regulatory guidelines, and practice initiatives have improved pain management in infants, children, and adolescents, but obstacles remain. The aim of this study was to identify the prevalence and demographics of pain, as well as pain management practice patterns in hospitalized children in a tertiary-care university hospital. We prospectively collected data including patient demographics, presence/absence and location of pain, pain intensity, pain assessment documentation, analgesic use, side effects of analgesic therapy, and patient/family satisfaction. Two hundred male (58%) and female, medical and surgical (61%) patients, averaging 9 ± 6.2 years were studied. Pain was common (86%) and often moderate to severe (40%). Surgical patients reported pain more frequently when enrolled than did medical patients (99% vs. 65%). Female gender, age ≥5 years, and Caucasian race were all associated with higher mean pain scores. Furthermore, females and Caucasian children consumed more opioids than males and non-Caucasians. Identified obstacles to optimal analgesic management include lack of documented physician pain assessment (<5%), a high prevalence of “as needed” analgesic dosing, frequent opioid-induced side effects (44% nausea and vomiting, 27% pruritus), and patient/family dissatisfaction with pain management (2%-7%). The data demonstrated that despite a concentrated focus on improving pain management over the past decade, pain remains common in hospitalized children. Identification of patient populations and characteristics that predispose to increased pain (e.g., female, Caucasian, postoperative patient) as well as obstacles to analgesic management provide a focus for the development of targeted interventions and research to further improve care.

Section snippets

Setting and Sample

After obtaining Institutional Review Board approval, parental informed consent, and, when applicable, patient assent/consent, we enrolled a random sample of 200 patients ranging in age from 7 days to 21 years who were admitted to the Johns Hopkins Children’s Center from October 2007 to November 2008. One patient was withdrawn from the study because of incomplete data. Sampling days were determined based on the availability of the data collectors. Within a sampling day, subjects were chosen

Demographics

Patient characteristics are presented in Table 1. Mean age was 9 ± 6.2 years, and 65% of subjects (132) were ≥5 years old. One hundred twenty-four subjects (62%) were Caucasian, 59 (30%) were African-American, and 16 (8%) were another race. Approximately 90% were developmentally appropriate for age. More than 60% of patients were enrolled following an operative procedure (46% female, 54% male). The probability of being admitted for a surgical procedure as opposed to a medical complaint

Discussion

The treatment of pain has become an international priority in the medical and surgical management of children. Indeed, many professional guidelines have been advanced and regulatory agencies have set standards of care for pain assessment and treatment. In light of the advances in understanding and practice that research and these guidelines have produced, we thought it was an opportune time to reexamine the incidence and prevalence of pain and its treatment in hospitalized children. Our study

Acknowledgments

The authors acknowledge the support of the nursing staff of the Johns Hopkins Children’s Center and the Division of Pediatric Anesthesiology. They also acknowledge Cynthia Hayes for administrative support, Claire Levine for editorial review, and Dave Kozlowski for database design and technical support.

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    Supported by the Jacob and Hilda Blaustein Foundation and the Richard J. Traystman endowed chair in Pediatric Anesthesiology, Critical Care Medicine, and Pain Management.

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