Prevalence of moderate-severe pain in hospitalized children

Background: Acute pain management in children is often inadequate. The prevalence of pain in hospitalized children in the US is unknown. Methods: We reviewed clinical characteristics of all pediatric patients admitted to Mayo Eugenio Litta Childrens hospital during July 2009. Patients with moderatesevere pain were identified. For patients identified as having moderatesevere pain risk factors, analgesia regimens, and pain outcomes were reviewed. Results: The prevalence of moderatesevere in-hospital pain was 27% (95% C.I. 23% to 32%). Teenagers and infants experienced higher prevalence rates of moderatesevere pain (38% and 32% respectively) than children (17%, P < 0.001). In addition, patients admitted to medical services had much lower rates of moderatesevere pain (13%) than those admitted to surgical services (44%, P < 0.001). Regional anesthesia was used in eleven (7.2%) of the patients on surgical services. Acetaminophen was administered to 75% of patients with moderatesevere pain. Only 21% of these patients had nonsteroidal anti-inflammatory drugs (NSAIDS) available. Opioids were given scheduled to 36% of patients with moderatesevere pain and as needed to another 40%. Fifty-five percent of patients still had one or more episode of moderatesevere pain on the day following an initial diagnosis; however, this number decreased steadily over subsequent days. Eleven patients (13% of those diagnosed with moderatesevere pain) still had one or more episodes of daily moderatesevere pain by day four. Conclusions: The prevalence of moderatesevere pain in hospitalized children remains high. Analgesia regimens may not be optimal. Underutilization of regional anesthesia techniques may have contributed to increased pain scores. A large proportion of children diagnosed with moderatesevere pain may have persistent clinically significant pain in subsequent days.