背景

系统使用疼痛强度量表被认为是治疗住院儿童疼痛的先决条件，但早在10年前，人们就注意到缺乏强有力的证据支持使用疼痛强度量表与预期结果之间的假定正相关关系。

目标

重新评估支持在住院儿童中使用疼痛量表与患者结局之间关联的证据。

设计

系统文献回顾。

数据源

检索PubMed和CINAHL数据库，检索时间从建库到2020年4月15日。

评价方法

对所有文献进行了筛选，然后双人分别重复筛选感兴趣的全文。纳入对医院0-18岁儿童使用自我报告或基于行为的疼痛量表评估结果的研究，但排除紧急护理环境中的研究。

结果

在纳入的32项研究中，大多数研究都评估了包含一个或多个疼痛量表的复杂干预措施。过程结果(例如，记录)是最常被研究的。干预措施通常与改善疼痛评估文件有关，而对疼痛管理文件的影响是不一致的。然而，过程结果的改善并不一定导致更好的患者结果。关于患者的结果(例如，疼痛强度，副作用，或对治疗的满意度)，一些作者报道群组水平的疼痛强度降低，但对其他功能结果，如儿童和家长的满意度，以及安全性方面的影响不一致。方法学方面也存在问题，例如单薄的研究设计和小样本，使结果存在偏差，而且由于疼痛量表是作为复杂干预措施的一部分进行研究，因此不可能确定疼痛量表对整体效果的影响。

结论

尽管有理论基础的对疼痛的理解和临床经验都表明，疼痛量表的使用将对有疼痛的住院儿童产生影响，但仍有有限的证据支持这一观点。由于疼痛量表几乎只被作为复杂干预的一个方面进行研究，因此迫切需要研究确定复杂干预中的活性成分及其对儿童有意义的联合和个体结果的影响(例如减轻疼痛强度或改善功能)。

 

 

Background

Systematic use of pain intensity scales is considered a prerequisite for treatment of pain in hospitalized children, but already a decade ago, attention was called to the lack of robust evidence supporting the presumed positive association between their use and desired outcomes.

Objectives

To re-evaluate the evidence supporting the association between the use of pain scales and patient and process outcomes in hospitalized children.

Design

Systematic literature review.

Data sources

The online databases PubMed and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched from inception to April 15, 2020.

Review methods

We performed single screening of all records followed by duplicate screening of full texts of interest with a disagreement procedure in place. Studies where the authors evaluated outcomes from the use of self-report or behavioral-based pain scales in children 0–18 years in a hospital setting were included. Emergency care settings were excluded.

Results

In a majority of the 32 included studies, complex interventions that included one or more pain scales were evaluated. Process outcomes (e.g., documentation) were most frequently studied. Interventions were commonly associated with improved documentation of pain assessment, while the effect on pain management documentation was inconsistent. However, improvements in process outcomes did not necessarily result in better patient outcomes. In regard to patient outcomes (e.g., pain intensity, side effects, or satisfaction with treatment), some authors reported reduced pain intensity on group level, but the effect on other functional outcomes, child and parent satisfaction, and aspects of safety were inconsistent. Methodological issues, e.g., weak study designs and small samples, biased the results, and it was not possible to determine how pain scales contributed to the overall effects since they were studied as part of complex interventions.

Conclusions

Although both a theoretically founded understanding of pain and clinical experience suggest that the use of pain scales will make a difference for hospitalized children with pain, there is still limited evidence to support this notion.

As pain scales have been almost exclusively studied as an aspect of complex interventions, research that determines the active ingredient(s) in a complex intervention and their joint and individual effects on outcomes that are meaningful for the child (for example reduced pain intensity or improved function) are urgently needed.

原文链接：

https://www.sciencedirect.com/science/article/pii/S002074892030331X