An audit of paediatric pain prevalence, intensity, and treatment at a South African tertiary hospital

Abstract

Introduction: Pain in paediatric inpatients is common, underrecognised, and undertreated in resource-rich countries. Little is known about the status of paediatric pain prevention and treatment in low- and middle-income countries.

Objectives: This audit aimed to describe the prevalence and severity of pain in paediatric patients at a tertiary hospital in South Africa.

Method: A single-day prospective observational cross-sectional survey and medical chart review of paediatric inpatients at Grey's Hospital, Pietermaritzburg, South Africa.

Results: Sixty-three children were included, and mean patient age was 9.7 years (SD 6.17). Most patients (87%) had pain during admission, with 29% reporting preexisting (possibly chronic) pain. At the time of the study, 25% had pain (median pain score 6/10). The worst pain reported was from needle procedures, including blood draws, injections, and venous cannulation (34%), followed by surgery (22%), acute illness/infection (18%), and other procedures (14%). Pharmacological treatments included WHO step 1 (paracetamol and ibuprofen) and step 2 (tramadol, tilidine, and morphine) analgesics. The most effective integrative interventions were distraction, swaddling, and caregiver participation. Although a pain narrative was present in the majority of charts, only 16% had documented pain intensity scores.

Conclusion: The prevalence of pain in hospitalised children in a large South African Hospital was high and pain assessment inadequately documented. There is an urgent need for pain education and development of guidelines and protocols, to achieve better pain outcomes for children. This audit will be repeated as part of a quality-improvement initiative.

Keywords: Paediatric inpatients; Pain assessment; Pain intensity; Pain management; Pain prevalence.

Figure 1.

Intensity of the “worst cause of pain” in the 24 hours preceding the survey.

Figure 2.

Pharmacological treatment prescribed to patients who experienced pain during admission. NSAIDs, nonsteroidal anti-inflammatory drugs; tilidine, synthetic opioid analgesic.