title: Epidemiology and management of painful procedures in children in Canadian hospitals.
abstract: BACKGROUND
  Children being cared for in hospital undergo multiple painful procedures daily. However, little is known about the frequency of these procedures and associated interventions to manage the pain. We undertook this study to determine, for children in Canadian hospitals, the frequency of painful procedures, the types of pain management interventions associated with painful procedures and the influence of the type of hospital unit on procedural pain management.
  
  
  METHODS
  We reviewed medical charts for infants and children up to 18 years of age who had been admitted to 32 inpatient units at eight Canadian pediatric hospitals between October 2007 and April 2008. We recorded all of the painful procedures performed and the pain management interventions that had been implemented in the 24-hour period preceding data collection. We performed descriptive and comparative (analysis of variance, χ(2)) analyses.
  
  
  RESULTS
  Of the 3822 children included in the study, 2987 (78.2%) had undergone at least one painful procedure in the 24-hour period preceding data collection, for a total of 18 929 painful procedures (mean 6.3 per child who had any painful procedure). For 2334 (78.1%) of the 2987 children who had a painful procedure, a pain management intervention in the previous 24 hours was documented in the chart: 1980 (84.8%) had a pharmacologic intervention, 609 (26.1%) a physical intervention, 584 (25.0%) a psychologic intervention and 753 (32.3%) a combination of interventions. However, for only 844 (28.3%) of the 2987 children was one or more pain management interventions administered and documented specifically for a painful procedure. Pediatric intensive care units reported the highest proportion of painful procedures and analgesics administered.
  
  
  CONCLUSIONS
  For less than one-third of painful procedures was there documentation of one or more specific pain management interventions. Strategies for implementing changes in pain management must be tailored to the type of hospital unit.
authors.affiliation: The Hospital for Sick Children, Toronto, Ont. b.stevens@utoronto.ca
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Stevens
authors.forename: Laura K
authors.initials: LK
authors.lastname: Abbott
authors.forename: Janet
authors.initials: J
authors.lastname: Yamada
authors.forename: Denise
authors.initials: D
authors.lastname: Harrison
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stinson
authors.forename: Anna
authors.initials: A
authors.lastname: Taddio
authors.forename: Melanie
authors.initials: M
authors.lastname: Barwick
authors.forename: Margot
authors.initials: M
authors.lastname: Latimer
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Scott
authors.forename: Judith
authors.initials: J
authors.lastname: Rashotte
authors.forename: Fiona
authors.initials: F
authors.lastname: Campbell
authors.forename: G Allen
authors.initials: GA
authors.lastname: Finley
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D000704:Analysis of Variance; D002170:Canada / Q000453:epidemiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D018709:Statistics, Nonparametric
chemical_list: D000700:Analgesics