護理SCI晨讀:支持在住院兒童中使用疼痛量表和預後之間關係的證據...

支持在住院兒童中使用疼痛量表和預後之間關係的證據:一項系統綜述

 

背景

系統使用疼痛強度量表被認為是治療住院兒童疼痛的先決條件，但早在10年前，人們就注意到缺乏強有力的證據支持使用疼痛強度量表與預期結果之間的假定正相關關係。

目標

重新評估支持在住院兒童中使用疼痛量表與患者結局之間關聯的證據。

設計

系統文獻回顧。

數據源

檢索PubMed和CINAHL資料庫，檢索時間從建庫到2020年4月15日。

評價方法

對所有文獻進行了篩選，然後雙人分別重複篩選感興趣的全文。納入對醫院0-18歲兒童使用自我報告或基於行為的疼痛量表評估結果的研究，但排除緊急護理環境中的研究。

結果

在納入的32項研究中，大多數研究都評估了包含一個或多個疼痛量表的複雜幹預措施。過程結果(例如，記錄)是最常被研究的。幹預措施通常與改善疼痛評估文件有關，而對疼痛管理文件的影響是不一致的。然而，過程結果的改善並不一定導致更好的患者結果。關於患者的結果(例如，疼痛強度，副作用，或對治療的滿意度)，一些作者報導群組水平的疼痛強度降低，但對其他功能結果，如兒童和家長的滿意度，以及安全性方面的影響不一致。方法學方面也存在問題，例如單薄的研究設計和小樣本，使結果存在偏差，而且由於疼痛量表是作為複雜幹預措施的一部分進行研究，因此不可能確定疼痛量表對整體效果的影響。

結論

儘管有理論基礎的對疼痛的理解和臨床經驗都表明，疼痛量表的使用將對有疼痛的住院兒童產生影響，但仍有有限的證據支持這一觀點。由於疼痛量表幾乎只被作為複雜幹預的一個方面進行研究，因此迫切需要研究確定複雜幹預中的活性成分及其對兒童有意義的聯合和個體結果的影響(例如減輕疼痛強度或改善功能)。

 

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.

 

原文連結：

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