Pain management in hospitalized children: A cross-sectional study

This is an observational, cross-sectional, retrospective and descriptive study of quantitative approach, carried out in a secondary hospital in the city of São Paulo, through analysis of 1,251 medical records of children admitted to the pediatric department. Data were tabulated and analyzed through descriptive statistics.

Results:

A total of 88.8% of children were assessed for pain with standardized instruments and 86% had analgesia prescribed. Among the assessments, 37.8% of the children had pain; of these, 26% had severe pain, greater in orthopedic conditions; 18.3% were not medicated, even with the presence of pain and prescribed analgesia; 4.3% had no analgesics prescribed; only 0.4% received non-pharmacological measures, and 40.3% had a report of reassessment. Professionals provided greater analgesia to children with surgical and orthopedic conditions compared to clinical conditions (p < 0.05).

Conclusion:

Pain management in hospitalized children is ineffective, from initial assessments to reassessments after interventions, with prioritization of medication actions guided by professional judgment in the face of pain complaints.

DESCRIPTORS
Pain; Pain Management; Child Health; Pediatric Nursing

	Mean (min – max)	95% CI
Age (years)	3.6 (28 days–14 years)	–
Sex	N (%)	95% CI
Female	533 (42.61)	[39.89–45.36]
Male	718 (57.39)	[54.64–60.11]
Causes of hospitalization	N (%)	95% CI
Respiratory	762 (61.40)	[58.66–64.07]
Surgical	209 (16.84)	[14.86–19.03]
Orthopedic	48 (3.87)	[2.93–5.09]
Infectious	39 (3.14)	[2.31–4.27]
Neurological	38 (2.26)	[1.57–3.24]
Nephrological	33 (2.66)	[1.90–3.71]
Digestive	29 (2.34)	[1.63–3.34]
ENT	21 (1.69)	[1.11–2.57]
Hematological	20 (1.61)	[1.05–2.48]
Metabolic	14 (1.13)	[0.67–1.88]
Others	38 (3.06)	[2.24–4.17]
Length of stay (days)	Mean (min – max)	95% CI
Respiratory	4.68 (0–305)	[3.0–3.5]
Surgical	5.52 (0–366)	[2.5–3.5]
Orthopedic	3.0 (1–23)	[1.5–3.0]
Infectious	7.36 (1–94)	[3.0–5.5]
Neurological	5.46 (1–37)	[3.0–5.5]
Nephrological	3.97 (1–11)	[3.0–4.0]
Digestive	4.41 (1–30)	[2.0–3.5]
ENT	4.57 (0–12)	[3.0–6.5]
Hematological	3.4 (1–9)	[2.5–4.0]
Metabolic	8.21(3–14)	[6.0–10.5]
Others	10.05 (0–280)	[2.0–4.0]
Presence of pain	N (%)	95% CI
Yes	481 (38.7)	[36.03–41.44]
No	761 (61.3)	[58.56–63.97]
Use of validated instrument for pain assessment	N (%)	95% CI
Yes	1,172 (88.8)	[32.41–38–28]
No	79 (11.2)	[50.22–51.45]
Scale Used*	N (%)	95% CI
NIPPS (Newborns to months)	70 (5.63)	[4.48–7.06]
FLACC (2 months to 7 years and neuropathic patients)	912 (73.37)	[70.83–75.75]
Faces (3 years)	44 (3.52)	[2.65–4.72]
Numerical (>7 years)	264 (21.32)	[19.13–23.68]
Nursing Diagnosis: Acute pain	N (%)	95% CI
Yes	375 (30.1)	[27.61–32.7]
No	871 (69.9)	[67.3–72.39]

Medicines*	Total number of children (N = 1251)	Children with pain (N = 481)
Medicines*	Prescribed N (%)	Prescribed N (%)	Administered N (%)
Dipyrone	1015 (81.1)	428 (88.9)	366 (76.1)
Paracetamol	213 (17.1)	118 (24.5)	110 (22.8)
Ketoprofen	102 (8.1)	82 (17)	79 (16.4)
Tramal	77 (6.1)	64 (13.3)	63 (13.1)
Ketorolac	48 (3.8)	35 (7.3)	34 (7.1)
Ibuprofen	40 (3.2)	21 (4.3)	19 (3.9)
Morphine	18 (1.4)	18 (3.7)	18 (3.7)
Codeine	2 (0.1)	1 (0.2)	1 (0.2)
Gabapentin	2 (0.1)	2 (0.4)	2 (0.4)
Xylocaine Spray	2 (0.1)	1 (0.2)	1 (0.2)
Simethicone	1 (0.07)	0 (0)	0 (0)
Buscopan	1 (0.07)	1 (0.2)	1 (0.2)
Xylocaine Gel	1 (0.07)	1 (0.2)	1 (0.2)
Dolantine	1 (0.07)	1 (0.2)	1 (0.2)

Presence of pain = 481 children
Specialty	Presence of pain	Pain intensity			Medicines
	Presence of pain	Pain intensity			Prescribed	Administered
	N (%)	Mild N (%)	Moderate N (%)	Severe N (%)	Mean (min – max)	N (%)
Respiratory	222 (46.1)	148 (66.6)	58 (26.2)	16 (7.2)	1 (1–4)	159 (71.6)
Surgical	120 (24.9)	20 (16.6)	33 (27.6)	67 (55.8)	2 (1–5)	112 (93.3)
Orthopedic	30 (6.2)	5 (16.6)	6 (20.0)	19 (63.4)	3 (1–6)	28 (93.3)
Infectious	16 (3.4)	5 (31.2)	7 (43.8)	4 (25,0)	2 (1–5)	13 (81.2)
Neurological	10 (2.0)	3 (30.0)	2 (20,0)	5 (50,0)	2 (1–4)	10 (100)
Nephrological	20 (4.0)	9 (45.0)	10 (50.0)	1 (5,0)	2 (1–5)	17 (85)
Digestive	18 (3.6)	8 (44.4)	7 (38.9)	3 (16.7)	2 (1–4)	14 (77.7)
ENT	12 (2.4)	9 (75.0)	2 (16.6)	1 (8.4)	2 (1–3)	10 (83.3)
Hematological	11 (2.8)	3 (27.2)	4 (36.4)	4 (36.4)	1 (1–3)	9 (81.8)
Metabolic	7 (1.4)	2 (28.6)	2 (28.6)	3 (42.8)	1 (1–3)	7 (100)
Others	15 (3.2)	9 (60.0)	4 (26.7)	2 (13.3)	2 (1–3)	14 (93.3)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Joese Aparecida Carvalho Av. Dr. Enéas de Carvalho Aguiar, 419, Cerqueira César 05403-000 – São Paulo, SP, Brazil Joesecarval@gmail.com

Brasil

Brasil

Pain management in hospitalized children: A cross-sectional study* * Extracted from the dissertation: “O manejo da dor em crianças hospitalizadas: Um estudo retrospectivo”, Escola de Enfermagem da Universidade de São Paulo, 2019.