title: Acute pain management in burn patients: appraisal and thematic analysis of four clinical guidelines.
abstract: OBJECTIVE
  Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units.
  
  
  METHODS
  The study had a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II, and identified core themes in the guidelines.
  
  
  RESULTS
  The overall scores expressing quality in six domains of the AGREE instrument were variable at 22% (DK), 44% (SE), 100% (NZ), and 78% (USA). The guidelines from NZ and USA were highly recommended, the Swedish was recommended, whereas the Danish was not recommended. The identified core themes were: continuous pain, procedural pain, postoperative pain, pain assessment, anxiety, and non-pharmacological interventions.
  
  
  CONCLUSIONS
  The study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes.
authors.affiliation: Department of Anesthesiology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark. Electronic address: Hgamst@yahoo.com.
authors.forename: Hejdi
authors.initials: H
authors.lastname: Gamst-Jensen
authors.affiliation: Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.
authors.forename: Pernille Nygaard
authors.initials: PN
authors.lastname: Vedel
authors.affiliation: Department of Anesthesiology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.
authors.forename: Viktoria Oline
authors.initials: VO
authors.lastname: Lindberg-Larsen
authors.affiliation: Faculty of Health & Medical Sciences, University of Copenhagen, Denmark; Trauma Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Egerod
mesh_terms: D059787:Acute Pain / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D000223:Adaptation, Psychological; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy* / Q000523:psychology; D002053:Burn Units; D002056:Burns / Q000150:complications / Q000523:psychology / Q000628:therapy*; D002648:Child; D003718:Denmark; D019317:Evidence-Based Medicine; D006801:Humans; D006991:Hypnosis, Anesthetic; D009520:New Zealand; D059408:Pain Management / Q000523:psychology / Q000592:standards*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000523:psychology / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D013548:Sweden; D014481:United States
chemical_list: D000700:Analgesics; D014151:Anti-Anxiety Agents
keywords: AGREE instrument; Burns; Clinical guidelines; Pain management; Pediatrics