Marianne J E van der Heijden1, Alette de Jong2, Heinz Rode3, Roux Martinez4, Monique van Dijk5. 1. Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands. Electronic address: m.j.e.vanderheijden@erasmusmc.nl. 2. Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Association of Dutch Burn Centers, Beverwijk, The Netherlands; Department of Rehabilitation, Nursing Science and Sports, University Medical Center, Utrecht, The Netherlands. Electronic address: aeedejong@rkz.nl. 3. Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Electronic address: heinz.rode@uct.ac.za. 4. Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Electronic address: rouxmartinez@gmail.com. 5. Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Department of Paediatrics, division of Neonatology and Department of Paediatric Surgery, Intensive Care, Erasmus MC, Rotterdam, The Netherlands. Electronic address: m.vandijk.3@erasmusmc.nl.
Abstract
OBJECTIVE: While the prevalence of burns in children is highest in low and middle-income countries, most research on burn-related pain intensity and distress is carried out in high-income countries. In this study we assessed pain intensity and distress in paediatric patients with burns undergoing wound care procedures without distraction and parental presence in a South-African children's hospital and sought to identify predictors for the outcomes. METHODS: This observational study, carried out as part of a randomized controlled trial, took place at a burns unit in Cape Town, South Africa and included patients between the ages of 0 and 13 years undergoing their first or second wound care procedure. We measured pain intensity and distress using the COMFORT Behavioural scale (COMFORT-B) across four distinct phases of wound care procedures: removal of bandage; washing the wound; administering wound care; putting on new dressings. COMFORT-B scores ≥21 indicate severe pain intensity and distress. RESULTS: 124 patients were included, median age 21.2 months (IQR 14.9-39.5 months), 90% suffered scalds, and median total body surface 8% (IQR 5-14%). Assessment scores for the majority of patients were indicative of severe pain intensity and distress during wound care procedures. Median COMFORT-B scores across the four phases were 24, 25, 25 and 22 respectively. Across the four phases respectively 76%; 89%; 81% and 62% of the patients were indicated with severe pain intensity and distress. Age was a predictor for pain intensity and distress as younger children were assigned higher scores than older children (Unstandardized B -.052; 95% CI -.071 to -.032 p<0.001). CONCLUSIONS: In this study children received wound care procedures without distraction or parental presence and were assessed to have high pain intensity and distress. There is a correlation between age and COMFORT-B scores: younger children show higher distress, indicating a great need for better pain and distress control during wound care procedures. It is difficult to identify whether pain or distress is the specific primary cause for the high COMFORT-B scores.
OBJECTIVE: While the prevalence of burns in children is highest in low and middle-income countries, most research on burn-related pain intensity and distress is carried out in high-income countries. In this study we assessed pain intensity and distress in paediatric patients with burns undergoing wound care procedures without distraction and parental presence in a South-African children's hospital and sought to identify predictors for the outcomes. METHODS: This observational study, carried out as part of a randomized controlled trial, took place at a burns unit in Cape Town, South Africa and included patients between the ages of 0 and 13 years undergoing their first or second wound care procedure. We measured pain intensity and distress using the COMFORT Behavioural scale (COMFORT-B) across four distinct phases of wound care procedures: removal of bandage; washing the wound; administering wound care; putting on new dressings. COMFORT-B scores ≥21 indicate severe pain intensity and distress. RESULTS: 124 patients were included, median age 21.2 months (IQR 14.9-39.5 months), 90% suffered scalds, and median total body surface 8% (IQR 5-14%). Assessment scores for the majority of patients were indicative of severe pain intensity and distress during wound care procedures. Median COMFORT-B scores across the four phases were 24, 25, 25 and 22 respectively. Across the four phases respectively 76%; 89%; 81% and 62% of the patients were indicated with severe pain intensity and distress. Age was a predictor for pain intensity and distress as younger children were assigned higher scores than older children (Unstandardized B -.052; 95% CI -.071 to -.032 p<0.001). CONCLUSIONS: In this study children received wound care procedures without distraction or parental presence and were assessed to have high pain intensity and distress. There is a correlation between age and COMFORT-B scores: younger children show higher distress, indicating a great need for better pain and distress control during wound care procedures. It is difficult to identify whether pain or distress is the specific primary cause for the high COMFORT-B scores.