Procedural pain and distress in young children as perceived by medical and nursing staff.
BACKGROUND
Currently there is no comparison of pain and distress experienced by young children undergoing a range of procedures. This would be important when considering choices between alternative management approaches and to facilitate development of measures to reduce procedural pain and distress. We set out to determine staff perceptions of pain and distress across a range of common emergency procedures.


METHODS
Standardised survey of medical and nursing staff in the emergency department (ED) of a large urban tertiary children's hospital. Staff perceptions of pain and distress of common ED procedures were measured using a 10 cm visual analogue scale. It included 15 common ED procedures, ranging from suprapubic aspiration (SPA) to measurement of oxygen saturation when performed in a child aged 12-18 months. It included four trauma related procedures. Respondents were stratified by their experience level with the procedures (50 procedures or less = less experienced, greater than 50 procedures = more experienced).


RESULTS
Ninety-two of 150 medical and nursing staff in the ED (61%) responded including almost all full time staff. Twenty-one percent of respondents were senior nurses, 17% senior physicians. The procedure considered the most painful was SPA [5.7 (4.0-7.2)cm]; as well as intramuscular injection (IMI) and lumbar puncture (LP). The procedures considered the most distressing were nasogastric tube (NGT) insertion [7.8(6.6-8.7)cm] as well as i.v. insertion and LP. All procedures were rated overall as more distressing than painful. Pain and distress were overall rated similarly regardless of staff experience level.


CONCLUSIONS
SPA, IMI and LP are perceived by emergency staff as most painful and NGT insertion, i.v. insertion and LP are perceived as most distressing. These findings are important for clinicians when choosing alternative treatment strategies and for researchers in planning future investigations to reduce procedural pain and distress.
Babl
Franz E
FE
Emergency Department, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia. franz.babl@rch.org.au
Mandrawa
Christine
C
O'Sullivan
Ronan
R
Crellin
Dianne
D
D001315:Australia; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D010146:Pain / Q000145:classification* / Q000209:etiology; D010147:Pain Measurement; D011795:Surveys and Questionnaires