Methods
drugs;Type of analgesia;Dosage, Pain, interview;Pain, pain, Consolability, NCT04209764, cognitive deficits, Index);Pain, NRS
In this cross-sectional and monocentric study, all patients in ordinary or day hospitalization in the Department of Surgery (DS) and the Department of Onco-Hematology and Cell and Genetic Therapy (DO) were included; no study-specific exclusion criteria were applied. If patients with language barriers were present in the wards, the protocol also envisaged their enrollment since datareport a sub-optimal pain therapy in this patient category [The study was approved by the Ethics Committee of the Ospedale Pediatrico Bambino Gesù IRCCS (1744_OPBG_2019) and it was registered with ClinicalTrials.gov, number (NCT04209764). The study was conducted on 25th January 2020.Pain prevalence was calculated as the proportion of patients reporting pain sensation out of the total number of patients included in the investigation.Pain was assessed according to the Hospital Pain Assessment Protocol previously described [Pain was assessed during usual care. The individual pain intensity scores obtained were converted to a common four-level metric (none, mild, moderate, and severe pain). For the Verbal Descriptive Scale, the scores were converted into four levels whereby no pain was converted to none; a little pain to mild; medium pain to moderate; and a lot of pain to severe. For the Numerical Rating Scale (NRS), the Visual Analogic Scale (VAS), and the Face, Legs, Arms, Cry and Consolability Scale (FLACC) scores were also converted as follows: 0 = no pain, 1 to 3 = mild pain, 4 to 6 = moderate pain and > 6 = severe pain [The relevant data for the study were obtained from the patient’s health records and through the administration of a questionnaire to hospitalized patients or their parents.For the purposes of the study, the following information will be collected:
Gender;Date of birth;Weight;Date of admission;Reason for admission;Ward of hospitalization and department;Presence of language barriers;Cognitive impairment of pain before admission;Presence of pain detected at different times: before hospitalization, during hospitalization, at the time of the interview and in the 24 h prior to the interview;Pain intensity detected at different times (before hospitalization, during hospitalization, at the time of the interview and in the 24 h prior to the interview) and defined as mild or moderate-severe [Administration of analgesic drugs;Type of analgesia;Dosage of analgesic drugs;Frequency of administration per hour or in continuous infusion over 24 h;Value of the PMI (Pain Management Index);Pain assessment;Frequency of pain assessment;Changes to analgesic therapy, if moderate pain;Efficacy of the analgesic drug administered;Adequacy of the administered analgesic drug defined according to WHO guidelines;Adequacy of information on pain relief at discharge.To reduce the effect of potential distortions during the data collection phase, all questionnaires were administered in a standardized manner by trained personnel, not directly involved in the care of the subjects of the study and not aware of the start date of the survey. The survey was carried out during a specific time interval (from 8:00 AM to 05:00 PM) on a single day, in order to obtain a picture of the pain prevalence in a common working day in the Departments concerned. The survey was conducted by 4 investigators consisting of 4 pediatric anesthesiologists with specific pain management training, not involved in the subjects’ care, with the task of administering informed consent, (provided for parents and adolescents) and a data collection questionnaire for hospitalized patients or their parents. In the case of patients and families with language barriers, the intervention of cultural mediators was envisaged. The questionnaire was administered only after the acquisition of informed consent.Interviewers used a data collection form on which the following parameters were recorded:
Demographic: age, sex, weight, presence of language barriers or cognitive deficits of pain before hospitalization and during hospitalization.Pain: pain assessment by FLACC scale for children up to 4 years and by NRS or VAS scales for children up to 18 years. The presence, intensity and characteristics of pain was observed at the time of the interview and in the previous 24 h.Analgesia: administration of analgesic drugs, type of analgesia and frequency of drug administration, modifications to therapy if moderate pain, adequacy of the analgesic drug administered according to the WHO guidelines, PMI which derives from the relationship between the Pain Score (derived from pain assessment) and Analgesic Score (derived from the type of drug used in relation to the analgesic scale WHO: no analgesic 0 points; WHO I: 1 point; WHO II: 2 points; WHO III: 3 points). Finally, using a scale from 1 to 10 points (poor = 0–2; sufficient = 3–4; good = 5–6, very good = 7–8; excellent 9–10) the patients or their relatives were able to evaluate the efficacy and the adequacy of the information received at discharge on pain relief therapy [