The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review.
Gregory A Whitley, Pippa Hemingway, Graham R Law and 3 others
PMID 32845710WHAT IT FOUND
Effective pre-hospital pain management in children is predicted by younger age, male sex, traumatic pain and analgesic administration.
Qualitative data show clinicians fear side effects and lack paediatric training, while parents feel excluded from care, creating barriers to effective treatment.
Key findings
01Predictors of effective pain management included male child sex, younger child age, traumatic type of pain, and analgesic administration.
02Barriers to care include clinician fear of side effects and punishment, inadequate paediatric education, and restrictive clinical guidelines.
03Parents reported that not being invited into care and encountering non-adjustable equipment caused lack of trust and increased stress.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The confidence in the cumulative evidence was deemed low due to the observational nature of the quantitative studies and methodological concerns in the qualitative studies. The voice of the child was not directly heard; findings relied on clinician and parent perspectives. Some quantitative studies used different definitions for effective pain management (e.g., ≥30% reduction vs ≥2/10 reduction). There is potential for inaccuracies in pain measurement in younger children who cannot verbalise, which may overestimate the effect of pain management strategies. The predictor 'child sex (male)' remains unexplained, and the conflict regarding 'child age (younger)' suggests complex barriers to treating younger children effectively.
Declared interests
The authors declared no potential conflicts of interest. The study was funded by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM). The funders had no role in the design, conduct, analysis, or manuscript preparation.
The easy way to misread this
Do not assume that younger children are easier to treat because they were a statistical predictor of effective pain management. The qualitative synthesis conflicted with this, showing that younger children are more difficult to assess and administer analgesics to, and that pain scales may be inaccurate in this group.