Prevalence of moderate-severe pain in hospitalized children
Prevalence of moderate-severe pain in hospitalized children
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DOI：
10.1111/j.1460-9592.2012.03807.x
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发表时间：
2012-07-01
影响因子：
1.7
通讯作者：
Harrison, Tracy E.
中科院分区：
文献类型：
--
作者：
Groenewald, Cornelius B.;Rabbitts, Jennifer A.;Harrison, Tracy E.
背景：儿童急性疼痛的管理往往是不够的。美国住院儿童疼痛的患病率未知。方法：我们回顾了2009年7月在马约EugenioLitta儿童医院收治的所有儿科患者的临床特征。中重度疼痛患者被确定。对于那些有中重度疼痛危险因素的患者，我们对镇痛方案和疼痛结果进行了回顾。结果：中重度住院疼痛的发生率为27%（95% C.I. 23%至32%）。青少年和婴幼儿中重度疼痛的患病率（分别为38%和32%）高于儿童（17%，P < 0.001）。此外，内科住院患者的中重度疼痛发生率（13%）明显低于外科住院患者（44%，P < 0.001）。11例（7.2%）手术患者使用了区域麻醉。75%的中重度疼痛患者服用了对乙酰氨基酚。这些患者中只有21%有非甾体抗炎药（NSAIDS）可用。36%的中重度疼痛患者按计划给予阿片类药物，另外40%的患者按需要给予阿片类药物。55%的患者在初次诊断后的第二天仍有一次或多次中度至重度疼痛发作;然而，这一数字在随后的几天内稳步下降。11名患者（13%的患者被诊断为中度至重度疼痛）在第4天仍有一次或多次中度至重度疼痛发作。结论：住院儿童中重度疼痛的患病率仍然很高。镇痛方案可能不是最佳的。局部麻醉技术利用不足可能导致疼痛评分增加。很大一部分诊断为中重度疼痛的儿童在随后的几天内可能会出现持续的临床显著疼痛。
Background: Acute pain management in children is often inadequate. The prevalence of pain in hospitalized children in the US is unknown. Methods: We reviewed clinical characteristics of all pediatric patients admitted to Mayo Eugenio Litta Childrens hospital during July 2009. Patients with moderatesevere pain were identified. For patients identified as having moderatesevere pain risk factors, analgesia regimens, and pain outcomes were reviewed. Results: The prevalence of moderatesevere in-hospital pain was 27% (95% C.I. 23% to 32%). Teenagers and infants experienced higher prevalence rates of moderatesevere pain (38% and 32% respectively) than children (17%, P < 0.001). In addition, patients admitted to medical services had much lower rates of moderatesevere pain (13%) than those admitted to surgical services (44%, P < 0.001). Regional anesthesia was used in eleven (7.2%) of the patients on surgical services. Acetaminophen was administered to 75% of patients with moderatesevere pain. Only 21% of these patients had nonsteroidal anti-inflammatory drugs (NSAIDS) available. Opioids were given scheduled to 36% of patients with moderatesevere pain and as needed to another 40%. Fifty-five percent of patients still had one or more episode of moderatesevere pain on the day following an initial diagnosis; however, this number decreased steadily over subsequent days. Eleven patients (13% of those diagnosed with moderatesevere pain) still had one or more episodes of daily moderatesevere pain by day four. Conclusions: The prevalence of moderatesevere pain in hospitalized children remains high. Analgesia regimens may not be optimal. Underutilization of regional anesthesia techniques may have contributed to increased pain scores. A large proportion of children diagnosed with moderatesevere pain may have persistent clinically significant pain in subsequent days.