Brudvik et al

What was the background context of Brudvik et al. (2016)?

Children often receive inadequate pain management especially in emergency departments. Analgesia is underused, delayed, or given in low doses. Poor pain management can cause short-term problems like delayed healing and long-term issues like anxiety or medical PTSD.

What was the main theory behind the study?

Pain is subjective and varies between individuals. Pain scales must be appropriate for children. Previous research shows doctors and parents underestimate children's pain compared to the children themselves.

What was the aim of Brudvik et al. (2016)?

Investigate agreement between child, parent, and physician pain ratings ; examine effects of age, condition, and severity on ratings ; assess how ratings influenced physicians’ decisions to give analgesia.

What was the research method and design?

Quasi-experimental, cross-sectional, quantitative comparative study.

What was the sample?

243 children aged 3 to 15 attending a Norwegian emergency department over 17 days ; 53 percent boys ; 51 physicians participated ; none were paediatric specialists.

What procedure was followed?

Children rated pain using age-appropriate scales (3 to 5 yrs: FPS-R ; 9 to 15 yrs: VAS and CAS). Parents and physicians rated pain using NRS 0 to 10. Parents rated before children but were not blind ; told not to share scores with physicians. Physicians completed questionnaires about experience, speciality, and own children. Conditions included soft tissue and ligament injuries, fractures, infections, wounds.

What were the mean ratings of pain by each group?

Children 5.5 ; Parents 4.8 ; Physicians 3.2.

What was the agreement between groups?

Physician vs child 14.6 percent ; Physician vs parent 15 percent ; Parent vs child 40.1 percent.

How did pain severity affect agreement?

Disagreement greater for mild pain with mean difference 3.2 ; reduced in moderate pain with mean difference 1.2 ; in severe pain sometimes physicians rated higher with mean difference minus 0.6.

What proportion of children received analgesia?

8.6 percent overall ; 4.1 percent with mild pain ; 9 percent with moderate pain ; 42 percent with severe pain. Based on children's self ratings only 14.3 percent with severe pain received medication.

What was the conclusion?

Physicians underestimated children’s pain compared to parents and children. More accurate for fractures and older children 8 plus.

GRAVE - Generalisability?

Large diverse child sample but limited to one Norwegian hospital ; cultural limits.

GRAVE - Reliability?

High because of standardised scales and quantitative measures.

GRAVE - Applicability?

Very applicable to improving children’s pain management globally.

GRAVE - Validity?

Strong ecological validity in real hospital but bias possible since parents not blind to child ratings.

GRAVE - Ethics?

Minimal concerns ; anonymised data. But participation may have delayed some children’s treatment.