Children and their parents’ assessment of postoperative surgical pain: Agree or disagree?
Introduction
Research indicates that up to 75% of all children undergoing surgery in the United States experience significant postoperative pain [1]. A large proportion of these children suffer from pain following discharge from the hospital in the home recovery phase [[2], [3], [4], [5], [6], [7], [8]]. In addition to the hardship associated with this clinical phenomenon, children who suffer from significant postoperative pain are more likely to experience delayed behavioral and clinical recovery [2,[9], [10], [11]].
It is well established that successful management of postoperative pain requires both reliable assessment of pain levels, as well as administration of the right analgesics in the right dosage and at the right time [[12], [13], [14], [15], [16]]. Within home settings, parents are most often responsible for managing their child's pain following surgery [9,10] and as such, parental assessment of child pain along with child assessment is of high significance. Previous research revealed conflicting results regarding agreement of pain ratings between parent-child dyads [11,14,[17], [18], [19]]. These previous studies suffer from a number of methodological flaws and have focused on describing pain rating disagreement and not predictors or clinical impact of such disagreement. We submit that assessing the impact of disagreement on actual clinical practice is of paramount importance and, if it is discovered that such a disagreement does not have any impact on clinical care or outcomes, then pain rating discrepancies between parents and children are less significant. In contrast, if such disagreement has clinical impact, it is highly important to identify predictors for such disagreement.
The primary aim of this study was to compare postoperative pain assessment between children and their parents in a population of children undergoing tonsillectomy and adenoidectomy (T&A), given this procedure is one of the most common pediatric surgeries and has been found to be associated with high levels of postoperative pain [12,20,21]. The study's secondary aims were to determine if any disagreement found had clinical impact in terms of analgesic administration by parents and to identify potential predictors for any disagreement found between children and parents.
Section snippets
Participants
This prospective longitudinal 5-year study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and was conducted from 2012 to 2017. The study included children undergoing outpatient T&A surgery and their parents and was aimed at evaluating a newly developed behavioral intervention that targeted reduction of preoperative anxiety in children. This 5-year study consisted of: 1) a baseline phase which lasted 2.5 years and consisted of only data
Results
A total of 311 parent-child dyads were included in this study. The reader is referred to Table 2 for a full description of the various demographic characteristics of the population reported in this manuscript. Participants primarily consisted of male children (50.2%) with a mean age of 6 ± 3 years, parent respondents were primarily mothers (85.2%), and English was the primarily language (74.0%).
Discussion
The goals of the study were to identify if there is disagreement on pain rating between children undergoing surgery and their parents, as well to examine if we can predict those parents and children who disagreed and to examine the potential impact of this disagreement on the administration of analgesics. Under the conditions of this study, we found that a significant proportion of parents and children were in disagreement in determining the children's postoperative pain severity in the first 3
Funding
This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)(R01HD048935).
Declarations of interest
ZNK is a paid speaker for Edwards Life Sciences, Medtronic, and the Studer Group.
Authorship & declaration of interest
Author names Authorship Conflict of interest: Corresponding:
Zeev N. Kain, MD MBAConception/design of study, conduct study, analyze/interpret data; draft and revise manuscript; final approval; accountability for the work. ZNK is a paid speaker for Edwards Life Sciences, Medtronic, and the Studer Group Olivia Kaminsky, BS Conception/design of study, conduct study, analyze/interpret data; draft and revise manuscript; final approval; accountability for the work. None Michelle A. Fortier, PhD
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