Comparison of pain management in paediatric surgical patients in two hospitals in France and Canada.
OBJECTIVE
Pain management in children has improved substantially over the last few years but continues to vary widely across institutions. Our objective was to describe the evaluation and treatment of pain in paediatric patients in two hospitals (Robert Debré in Paris, France, and Sainte-Justine, Montréal, Canada) and to compare conformity with quality criteria.


METHODS
Retrospective medical chart of a total of 200 patients with uncomplicated appendectomy, spinal fusion, ureteroneocystostomy, or laparoscopic cholecystectomy were analysed, with special attention to nurses' entries, prescriptions, and medication administration sheets.


METHODS
Patient characteristics and variables pertaining to pain evaluation (tool and result) and treatment (date, prescription and administration details) were collected. Quality criteria for evaluating conformity with guidelines were taken from the literature. Any change in medication, dosage, or dosing interval was taken as a new prescription.


RESULTS
About 929 prescriptions and 2,388 numerical pain scores were recorded for 200 patients. Pain was recorded at 70.8% of vital-sign evaluations at the Robert-Debré Hospital compared to 30.9% at the Sainte-Justine hospital (P < 0.0001). A validated age-appropriate pain evaluation tool was used in 97.4 and 94.1% of evaluations in these two hospitals, respectively (P < 0.0001). Analgesic dosage was appropriate in 92.5% of prescriptions at Robert-Debré and 86.0% of those at Sainte-Justine (P = 0.002).


CONCLUSIONS
This study documents differences in post-operative pain management between two paediatric hospitals. We found differences between the two hospitals regarding the frequency of pain evaluation, the use of validated tools for evaluating pain, and analgesic dosages. Continued efforts to educate prescribing physicians and other healthcare providers are needed to improve pain management in children.
Prot-Labarthe
Sonia
S
Hôpital Sainte-Justine, Département de pharmacie, Unité de Recherche en Pratique Pharmaceutique, Université de Montréal, Montréal, QC, Canada.
Pelletier
Elaine
E
Winterfeld
Ursula
U
Villeneuve
Edith
E
Wood
Chantal
C
Bussières
Jean-François
JF
Brion
Françoise
F
Bourdon
Olivier
O
D000293:Adolescent; D000367:Age Factors; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D001835:Body Weight / Q000502:physiology; D002170:Canada; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D005602:France; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies
D000700:Analgesics