Abstract
We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: ‘child sex (male)’, ‘child age (younger)’, ‘type of pain (traumatic)’ and ‘analgesic administration’. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child’s experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration: PROSPERO CRD42017058960
Highlights
Pain is ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’ (International Association for the Study of Pain, 2020)
Access to pain management is considered a fundamental human right (Brennan et al, 2019), yet pre-hospital pain management in children is poor (Samuel et al, 2015). This is despite effective pain management being recently identified as a key quality outcome measure for emergency medical services (EMS) (Turner et al, 2019)
Analgesic administration rates for pre-hospital children suffering from acute pain have been low (Lerner et al, 2014; Lord et al, 2016; Whitley and Bath-Hextall, 2017)
Summary
Pain is ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’ (International Association for the Study of Pain, 2020). Access to pain management is considered a fundamental human right (Brennan et al, 2019), yet pre-hospital pain management in children is poor (Samuel et al, 2015). Other non-pharmacological approaches such as distraction, staying close to relatives and creating a calm environment are rarely documented or extracted for analysis (Pilbery et al, 2019). This lack of data, coupled with the complexity of pre-hospital pain management in children (Whitley et al, 2019), causes uncertainty when attempting to improve quality of care for children suffering from pain
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