# Repeated Cross-Sectional Survey Study of Pain Management in Portuguese Pediatric Emergency Departments (2007-2018)

## TL;DR

This study tracks changes in how pain is assessed and managed in Portuguese pediatric emergency departments from 2007 to 2018, showing some improvements but ongoing challenges.

## Contribution

The study provides a longitudinal analysis of pediatric pain management practices in Portuguese emergency departments over 11 years.

## Key findings

- Pain assessment improved significantly, with increased use of pain scales and local protocols.
- Mild to moderate pain management remains inadequate, with only 22% always using analgesia.
- Staff perceive pain management as suboptimal, indicating a need for more training and coordinated national efforts.

## Abstract

Objectives

The prevalence of pediatric pain, either related to the child’s hospital visit or because of diagnostic and/or therapeutical interventions, is of primordial importance in pediatric emergency departments (PEDs). In this study, we evaluate the evolution of pain assessment and management in Portuguese PEDs over 11 years.

Methods

We prepared a questionnaire addressed to head physicians of 45 Portuguese PEDs in 2007 and statistically compared the responses to those provided in 2018, where we also posed these questions to nurse managers.

Results

Pain assessment in our cohort of Portuguese PEDs has significantly improved, namely, with the establishment of local protocols and widespread use of pain scales (from 52% to 93%, p = 0.03). However, effective adoption of pain management remains insufficient, as mild to moderate pain is still far from being universally treated (only 22% always use analgesia). Nonetheless, there seems to be adequate treatment of severe pain and respective common use of opioids, but correct practices were not generally adopted when specific types of pain were analyzed. Procedural sedation and analgesia have significantly increased but are not yet universally practiced. In the year 2018, about 88% of these inadequacies are reflected by the staff’s perception that pain management remains suboptimal, and more training is needed.

Conclusion

The development of collective awareness and the institution of national guidelines for pediatric pain have helped to improve the conjuncture in Portuguese PEDs. However, a coordinated nationwide plan to promote local training and optimize knowledge translation is still lacking.