Nationwide study of headache pain in Italy shows that pain assessment is still inadequate in paediatric emergency care

Franca Benini, Simone Piga, Tiziana Zangardi, Gianni Messi, Caterina Tomasello, Nicola Pirozzi, Marina Cuttini, PIPER Study Group, Emanuela Piccotti, Luca Manfredini

Research output: Contribution to journalArticle

Abstract

AIM: Italian national guidelines on pain management were published in 2010, but there is little information on how effective pain management is in paediatric emergency care, with other countries reporting poor levels. Using headache as an indicator, we described pain assessment in Italian emergency departments and identified predictors of algometric scale use.

METHODS: All Italian paediatric and maternal and child hospitals participated, plus four general hospitals. Data on all children aged 4-14 years admitted during a one-month period with headache as their chief complaint were abstracted from clinical records. Multivariable analyses identified predictors of algometric assessment, taking into account the cluster study design.

RESULTS: We studied 470 admissions. During triage, pain was assessed using a standardised scale (41.5%), informally (15.5%) or was not recorded (42.9%). Only 32.1% of the children received analgesia in the emergency department. The odds ratios for predictors of algometric assessment were non-Italian nationality (3.6), prehospital medication (1.8), admission to a research hospital (7.3) and a more favourable nurses-to-admissions ratio of 10.8 for the highest versus lowest tertile.

CONCLUSION: Despite national guidelines, paediatric pain assessment in Italian emergency care was suboptimal. Hospital variables appeared to be stronger predictors of adequate assessment than patient characteristics.

Original languageEnglish
Pages (from-to)e200-8
JournalActa Paediatrica, International Journal of Paediatrics
Volume105
Issue number5
DOIs
Publication statusPublished - May 2016

Keywords

  • Adolescent
  • Child
  • Child, Preschool
  • Emergency Medical Services
  • Emergency Service, Hospital
  • Female
  • Guideline Adherence
  • Headache
  • Hospitals, General
  • Hospitals, Pediatric
  • Humans
  • Italy
  • Male
  • Pain Measurement
  • Pediatrics
  • Practice Guidelines as Topic
  • Quality Indicators, Health Care
  • Retrospective Studies
  • Triage
  • Journal Article
  • Observational Study
  • Research Support, Non-U.S. Gov't

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