title: Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals.
abstract: BACKGROUND
  Pain experienced by children in emergency departments (EDs) is often poorly assessed and treated. Although local protocols and strategies are important to ensure appropriate staff behaviours, few studies have focussed on pain management policies at hospital or department level. This study aimed at describing the policies and reported practices of pain assessment and treatment in a national sample of Italian pediatric EDs, and identifying the assocoated structural and organisational factors.
  
  
  METHODS
  A structured questionnaire was mailed to all the 14 Italian pediatric and maternal and child hospitals and to 5 general hospitals with separate pediatric emergency room. There were no refusals. Information collected included the frequency and mode of pain assessment, presence of written pain management protocols, use of local anaesthetic (EMLA cream) before venipuncture, and role of parents. General data on the hospital and ED were also recorded. Multiple Correspondence Analysis was used to explore the multivariable associations between the characteristics of hospitals and EDs and their pain management policies and practices.
  
  
  RESULTS
  Routine pain assessment both at triage and in the emergency room was carried out only by 26% of surveyed EDs. About one third did not use algometric scales, and almost half (47.4%) did not have local protocols for pain treatment. Only 3 routinely reassessed pain after treatment, and only 2 used EMLA. All EDs allowed parents' presence and most (17, 89.9%) allowed them to stay when painful procedures were carried out. Eleven hospitals (57.9%) allowed parents to hold their child during blood sampling. Pediatric and maternal and child hospitals, those located in the North of Italy, equipped with medico-surgical-traumatological ED and short stay observation, and providing full assessment triage over 24 hours were more likely to report appropriate policies for pain management both at triage and in ER. A nurses to admissions ratio ≥ median was associated with better pain management at triage.
  
  
  CONCLUSIONS
  Despite availability of national and international guidelines, pediatric pain management is still sub-optimal in Italian emergency departments. Multifaceted strategies including development of local policies, staff educational programs, and parental involvement in pain assessment should be carried out and periodically reinforced.
authors.affiliation: Unit of Epidemiology, Bambino Gesù Children's Hospital, Viale Ferdinando Baldelli 41, Rome 00146, Italy. marina.cuttini@opbg.net.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Ferrante
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
authors.forename: Tiziana
authors.initials: T
authors.lastname: Zangardi
authors.forename: Caterina
authors.initials: C
authors.lastname: Tomasello
authors.forename: Gianni
authors.initials: G
authors.lastname: Messi
authors.forename: Nicola
authors.initials: N
authors.lastname: Pirozzi
authors.forename: Valentina
authors.initials: V
authors.lastname: Losacco
authors.forename: Simone
authors.initials: S
authors.lastname: Piga
authors.forename: Franca
authors.initials: F
authors.lastname: Benini
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D059408:Pain Management / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D010147:Pain Measurement / Q000379:methods* / Q000592:standards; D010372:Pediatrics / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
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