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Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments

Korean Journal of Pain 2020년 33권 4호 p.386 ~ 394
황소연, 최유진, 정재윤, 최영호, 함은미, 박중완, 권혁술, 김도균, 곽영호,
소속 상세정보
황소연 ( Hwang So-Yun ) - Seoul National University Hospital Department of Emergency Medicine
최유진 ( Choi Yoo-Jin ) - Ajou University Hospital Department of Emergency Medicine
정재윤 ( Jung Jae-Yun ) - Seoul National University Hospital Department of Emergency Medicine
최영호 ( Choi Yeong-Ho ) - Seoul National University Hospital Department of Emergency Medicine
함은미 ( Ham Eun-Mi ) - Seoul National University Hospital Department of Emergency Medicine
박중완 ( Park Joong-Wan ) - Seoul National University Hospital Department of Emergency Medicine
권혁술 ( Kwon Hyuk-Sool ) - Seoul National University Bundang Hospital Department of Emergency Medicine
김도균 ( Kim Do-Kyun ) - Seoul National University Hospital Department of Emergency Medicine
곽영호 ( Kwak Young-Ho ) - Seoul National University Hospital Department of Emergency Medicine

Abstract


Background: In the emergency department (ED), adequate pain control is essential for managing patients; however, children with pain are known to receive less analgesia than adults with pain. We introduce the Pain Passport to improve pain management in paediatric patients with suspected fractures in the ED.

Methods: This was a before-and-after study. We reviewed the medical records of paediatric patients who were primarily diagnosed with fractures from May to August 2015. After the introduction of the Pain Passport, eligible children were enrolled from May to August 2016. Demographics, analgesic administration rates, time intervals between ED arrival and analgesic administration, and satisfaction scores were obtained. We compared the analgesic prescription rate between the two periods using multiple logistic regression.

Results: A total of 58 patients were analysed. The baseline characteristics of subjects during the two periods were not significantly different. Before the introduction of the Pain Passport, 9 children (31.0%) were given analgesics, while after the introduction of the Pain Passport, a significantly higher percentage of patients (24/29, 82.8%) were treated with analgesics (P < 0.001). The median administration times were 112 (interquartile range [IQR], 64-150) minutes in the pre-intervention period and 24 (IQR, 20-74) minutes in the post-intervention period. The median satisfaction score for the post-intervention period was 4 (IQR, 3-5). The adjusted odds ratio for providing analgesics in the post-intervention period was 25.91 (95% confidence interval, 4.36-154.02).

Conclusions: Patient-centred pain scoring with the Pain Passport improved pain management in patients with suspected fractures in the paediatric ED.

키워드

Analgesia; Analgesics; Child; Emergency Medical Services; Fractures; Bone; Pain; Pain Management; Standard of Care

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