Cross-sectional study: healthcare professionals’ perspective on pediatric pain assessment and management

Bárbara Martins Saraiva, Paediatric Unit, Hospital Dona Estefânia, Unidade Local de Saúde de São José, Lisbon, Portugal
Inês Gomes, Paediatric Unit, Hospital Garcia de Orta EPE, Unidade Local de Saúde de Almada, Lisbon, Portugal
Rita Marques, Paediatric Unit, Hospital Garcia de Orta EPE, Unidade Local de Saúde de Almada, Lisbon, Portugal
Marta Almeida, Paediatric Unit, Hospital Garcia de Orta EPE, Unidade Local de Saúde de Almada, Lisbon, Portugal
Cristina Esteves, Paediatric Unit, Hospital Garcia de Orta EPE, Unidade Local de Saúde de Almada, Lisbon, Portugal
Cristina Ferreira, Paediatric Unit, Hospital Garcia de Orta EPE, Unidade Local de Saúde de Almada, Lisbon, Portugal
Filipa Nunes, Paediatric Unit, Hospital Garcia de Orta EPE, Unidade Local de Saúde de Almada, Lisbon, Portugal

Introduction and Objectives: Pain is recognized as the fifth vital sign. Although guidelines on pain have increased greatly, two thirds of hospitalized children report experiencing uncontrolled pain. Our goal was to evaluate the knowledge of a pediatric healthcare team on pain assessment/management in all pediatric sectors. Methods: Cross-sectional study among doctors and nurses of all pediatric departments in a secondary hospital, July 2022. Statistical significance was analyzed concerning “career type” and “years of experience”. Statistically significant p-values were < 0.05. Results: A total of 81 out of 122 (66%) professionals answered (42% doctors; 58% nurses). Of these, 48% worked in the emergency department and 24% in intensive care. The median score was 12 out of 14 (86%) questions on a survey. Questions with lower scores concerned opioids. A total of 77% reported using pain assessment scales “often/always”: 75% named the appropriate scale for children aged four to six/over six, but only 44% could identify that for children under four years of age. Nurses use scales more frequently (p < 0.05). One third of those surveyed believed pain was only “sometimes” well treated. Three quarters used non-pharmacological interventions regularly, especially nurses (p = 0.01). Participants were highly confident using morphine (78%), fentanyl (69%), and ketamine (63%). Experienced doctors were more confident (p = 0.001). The most commonly chosen for mild, moderate, and severe pain were paracetamol/ibuprofen, ketorolac/tramadol, and fentanyl/ketamine, respectively, in accordance with current guidelines. Discussion: Theoretical knowledge was satisfactory; however, opioid training must be prioritized. There is a lack of experience with the application of scales for evaluating pain in children under four years of age. High levels of experience were noted in sedoanalgesia. Constant training is needed to guarantee professionals are highly experienced and to ensure the best treatment and care.

Keywords: Pediatric pain. Sedoanalgesia. Pain assessment. Pain awareness. Professionals�?? perspective. Hospital survey.