Pain management in the child in the emergency room: survey in Italian hospitals

Background: pain is a frequent symptom in pediatric age, especially in the emergency / urgency setting, despite this, the management of the symptom in clinical practice is still inadequate. Objectives: to provide an updated assessment of the state of the art of pediatric pain management in the emergency rooms of Italian hospitals. Materials and methods: 46 Italian emergency departments participating in the PIPER Study Group (“Pain In Pediatric Emergency Room”) were involved. A questionnaire was sent to these centers pain management in children in the emergency room. The information collected related to: characteristics and organization of first aid, frequency and methods of pain assessment and measurement, presence of written protocols for both pharmacological and non pharmacological pain management, adherence and implementation of strategies and Best Practices elaborated by the GdS PIPER. A descriptive analysis was performed on the data collected. Results: all PIPER centers agreed to participate. The centers involved had more than 900,000 accesses to the emergency room in the period in question. 74% of the centers measure pain in triage (nurse) and of these 80% record the algometric data collected in clinical records, given that in 2/3 of the cases it is a sufficient symptom to assign a code to the triage. 56% of the doctors always measure the pain at the time of the first visit to the emergency room and 28% also re-evaluate it later to measure the effectiveness of therapy. The adhesion to PIPER resulted in a significant change in 80% of centers in the correct use of anti-pain medication and greater sensitivity to the issue and aptitude for pain management. In 89% of the centers training courses were launched, in 59% the proposal and development of management protocols and in 72% the introduction of new tools for measuring pain were accepted. Conclusions: the correct management of pain in children in the emergency / urgency setting represents a goal that is still to be achieved. The study of new methods, the training for health personnel, information for users and research, are all appropriate tools to determine the real change in pain management in the child in the emergency room. From an initial assessment of how much the GdS PIPER has proposed and implemented in these years of activity, it is evident that it has an important role in the implementation of this change.