Abstract
BackgroundDespite the exceptional burden of burns in low- and middle-income countries (LMIC) and the importance of adequate analgesia in burn care, there is a lack of analgesia protocol developed in resource-scarce settings. This necessitates the development of an analgesia protocol applicable to the resource-scarce setting. This study presents the findings of a modified Delphi study aimed at achieving consensus by a panel of experts in the management of burn injuries from low- and middle-income settings across Africa.MethodsA two-round Delphi survey was conducted to achieve consensus on an analgesia protocol for paediatric burn patients for a resource-limited setting. The Delphi panel consisted of nine experts with experience in management of burn injuries in low-income settings.ResultsConsensus was determined by an a priori threshold of 80% of agreement for a drug to be included in the analgesia protocol. There was a largely overarching agreement with regard to the background analgesia protocol and strong agreement regarding the use of an initial dose of ketamine and midazolam for procedural sedation.ConclusionA modified Delphi method was used to obtain expert consensus for a recently adopted analgesia protocol for burn-injured children in a resource-limited setting, with experts in the management of burn injuries in low- and middle-income settings. The expert consensus leads to the rigour and robustness of the protocol. Delphi methods are exceptionally valuable in healthcare research and the aim of such studies is to find converging expert opinions.
Highlights
The burden of burn injuries on sub-Saharan countries, especially amongst children, is huge
This study presents the findings of a modified Delphi study aimed at achieving consensus by a panel of experts on pain management for burn injuries from low- and middleincome settings which could be adapted for application in other low- and middle-income countries (LMIC)’s across Africa
In accordance with the tenets of the Delphi approach, methodological rigour was maintained through the consensus of expert opinion from medical practitioners who are experienced in the management of burn-injured children in low-resource settings, albeit dispersed geographically across the African continent
Summary
The burden of burn injuries on sub-Saharan countries, especially amongst children, is huge. Pain control remains inadequate, in the sub-Saharan region but across the globe.[2,3,4,5] Adequate analgesia in burns is essential, but it is often difficult to achieve. Despite the exceptional burden of burns in low- and middle-income countries (LMIC) and the importance of adequate analgesia in burn care, there is a lack of analgesia protocol developed in resource-scarce settings. This necessitates the development of an analgesia protocol applicable to the resource-scarce setting. There was overarching agreement with regards to the use of paracetamol, ibuprofen, morphine and clonidine in a stepwise manner in the analgesia protocol. Increase in increments of 100 mg/dose up to 600 mg 8-hourly
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