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. 2021 Sep;25(3):481-503.
doi: 10.1177/1367493520949427. Epub 2020 Aug 26.

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

Gregory A Whitley  1 , Pippa Hemingway  2 , Graham R Law  1 , Arwel W Jones  3 , Ffion Curtis  4 , Aloysius N Siriwardena  1
Affiliations

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

Gregory A Whitley et al. J Child Health Care. 2021 Sep.

Abstract

We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: 'child sex (male)', 'child age (younger)', 'type of pain (traumatic)' and 'analgesic administration'. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child's experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration: PROSPERO CRD42017058960.

Keywords: Ambulance; analgesia; children; emergency medical services; pain.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Systematic mixed studies review modified segregated approach. Source: Adapted from Sandelowski et al. (2006) cited in Joanna Briggs Institute (2014).
Figure 2.
Figure 2.
Preferred reporting items for systematic review and meta-analysis flow diagram.
Figure 3.
Figure 3.
Thematic synthesis: analytical and descriptive themes.
See this image and copyright information in PMC

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