Meta-Analysis Predictors of Sufficient Pain Management among Children at Pre-hospital Medical Service
Abstract
Background: Safely treating pain in children is a critical but challenging task for emergency medical teams. Few studies have focused on pain management guidelines at the hospital or department level. This study aimed to examine predictors of good pain management in children in prehospital health services.
Subject and Method: This research is a systematic review and meta-analysis study using PRISMA diagrams. The article search was conducted based on the PICO Model eligibility criteria. P: children with pre-hospital acute Pain. I: analgesic administration and male. C: no analgesic administration, and female. O: pain reduction. The articles used were from 5 databases: EBSCO, Pubmed, ProQuest, Scopus, and Science Direct. The search keywords for articles were as follows “pain management” OR “pain reduction” AND “predictors” AND “pre-hospital care” AND “children”. The inclusion criteria in this study include full-text articles with observational study designs, full-text available articles, the relationship size used is the adjusted Odds Ratio, articles published in the 2010-2022 range, and the research outcome is sufficient pain management or efficient pain reduction. Articles were analyzed using the Review Manager 5.3 application.
Results: There are 8 articles in this study, 2 from Australia, 1 from the United States, 1 from Switzerland, and 4 articles from the United Kingdom. The article was analyzed using the PRISMA flow diagram. The study results show that analgesic administration has increased the odds of 3.36 times greater for pain reduction than without analgesic administration. This result was statistically significant (aOR= 3.36; 95% CI = 1.94 to 5.82; p<0.001). However, no significant results from the gender that showed there is no different between male and female patients for pain reduction (aOR= 1.12; 95% CI= 0.98 to 1.27; p= 0.100).
Conclusion: Analgesic administration is sufficient pain management for children with acute Pain in pre-hospital medical care.
Keywords: children, pre-hospital care, pain management, predictors
Correspondence: Arief Wahyudi Jadmiko. Nursing Department, Faculty of Health, Universitas Pembangunan Nasional Veteran Jakarta. Jl. Raya Limo Depok 16515 West Java, Indonesia. Email: ariefwjadmiko@gmail.com. Mobile: 085647213628.
Indonesian Journal of Medicine (2022), 07(04): 360-370
https://doi.org/10.26911/theijmed.2022.07.04.01
References
Albrecht E, Taffe P, Yersin B, Schoettker P, Decosterd I, Hugli O (2013). Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study. Br J Anaesth. 110(1):96106. Doi: 10.1093/bja/aes355.
Brennan F, Lohman D, Gwyther L (2019). Access to Pain Management as a Human Right. Am. J. Public Health. 109(1): 61–65. Doi: 10.2105/AJPH.2018.304743.
Eccleston C, Fisher E, Howard RF, Slater R, Forgeron P, Palermo TM, Birnie KA, et al. (2021). Delivering transformative action in paediatric pain: a Lancet Child and Adolescent Health Commission. Lancet Child Adolesc Health. 5(1):4787. Doi: 10.1016/S23524642(20)302777.
Friesgaard KD, Riddervold IS, Kirkegaard H (2018). Acute pain in the prehospital setting: a registerbased study of 41,241 patients. Scand J Trauma Resusc Emerg Med. 26:53. Doi: 10.1186/s1304901805212
Galinski M, Ruscev M, Gonzalez G, Kavas J, Ameur L, Biens D, Lapostolle F, et al.(2010). Prevalence and management of acute pain in prehospital emergency medicine. Prehosp Emerg Care. 14(3):334339. Doi: 10.3109/10903121003760218.
GauscheHill M, Brown KM, Oliver ZJ, Sasson C, Dayan PS, Eschmann NM, Weik TS, et al. (2014). An Evidencebased Guideline for prehospital analgesia in trauma. Prehosp Emerg Care. 1: 2534. Doi: 10.3109/10903127.2013.844873.
Jennings PA, Cameron P, Bernard S (2011). Epidemiology of prehospital pain: an opportunity for improvement. Emerg Med J. 28(6): 530–531. Doi: 10.1136/emj.2010.098954.
Lord B, Jennings PA, Smith K (2016). The epidemiology of pain in children treated by paramedics. Emerg. Med. Australas. 28(3): 319–324. Doi: 10.1111/17426723.12586.
McManus JGJ, Sallee DRJ (2005). Pain management in the prehospital environment. Emerg. Med. Clin. N. Am. 23(2): 415–431. Doi: 10.1016/j.emc.2004.12.009.
Murphy A, McCoy S, O'Reilly K, Fogarty E, Dietz J, Crispino G, Wakai A, et al. (2016). Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance. Prehosp Emerg Care. 20(1):528. Doi:10.3109/10903127.2015.1037478.
Oberholzer N, Kaserer A, Albrecht R, Seifert B, Tissi M, Spahn DR, Maurer K, et al.(2017). Factors Influencing Quality of Pain Management in a Physician Staffed Helicopter Emergency Medical Service. Anesth Analg. 125(1):200209. Doi: 10.1213/ANE.0000000000002016.
National Association of State EMS Officials (2014). National model EMS clinical guidelines.
Park CL, Roberts DE, Aldington DJ, Moore RA (2010). Prehospital analgesia: systematic review of evidence. J R Army Med Corps. 4:(1):295300. Doi: 10.1136/jramc15604s05.
Raja SN (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 161(9): 1976–1982. Doi: 10.1097/j.pain.0000000000001939.
Samuel N, Steiner IP, Shavit I (2015). Prehospital pain management of injured children: a systematic review of current evidence. Am. J. Emerg. Med. 33(3): 451–454. Doi: 10.1016/j.ajem.2014.12.012.
Siriwardena AN, Shaw D, Bouliotis G (2010). Exploratory crosssectional study of factors associated with prehospital management of pain. J. Eval. Clin. Pract. 16(6): 1269–1275. Doi: 10.1111/j.13652753.2009.01312.x.
Snooks HA, Evans BA, Wells B, Peconi J (2015). What are the highest priorities for research in prehospital care? Results of a review and Delphi consultation exercise. Australas. J. Paramed. 6(4). Doi: 10.33151/ajp.6.4.471.
Sokoloff C, Daoust R, Paquet J, Chauny JM (2014). Is adequate pain relief and time to analgesia associated with emergency department length of stay? A retrospective study. BMJ Open. 4(3):e004288. Doi: 10.1136/bmjopen2013004288.
Turner J, Siriwardena AN, Coster J, Jacques R, Irving A, Crum A, Gorrod HB, et al. (2019). Developing new ways of measuring the quality and impact of ambulance service care: the PhOEBE mixedmethods research programme. Doi: 10.3310/pgfar07030.
Whitley GA, Pilbery R (2019). Prehospital intranasal analgesia for children suffering pain: a rapid evidence review. Br. paramed. j. 4(3): 24–34. Doi: 10.29045/14784726.2019.12.4.3.24.
Yousefifard M, AskarianAmiri S, Madani Neishaboori A, Sadeghi M, Saberian P, Baratloo A (2019). Prehospital pain management; a systematic review of proposed guidelines. Arch Acad Emerg Med. 7(1): e55.