Barriers and facilitators to out-of-hospital pain management for children

Pain is one of the most common symptoms presented by patients of all ages to ambulance services. While children in pain make up a relatively small proportion of the patients attended by prehospital care services, medical intervention is needed in only 40% of cases. This might go some way to explaining why management of paediatric pain is perceived as poor. Aim: To establish and explore published barriers and facilitators to out-of-hospital pain management for children aged <18 years. Methods: Key search terms were used to search the three databases (CINAHL, MEDLINE and PSYCHInfo) individually and simultaneously. Inclusion and exclusion criteria were applied and 15 papers were identified as meeting the criteria and were subject to data extraction. Results: Three broad themes were identified; organisational factors, patient factors and clinician factors. Conclusion: From considering international systems and aspects of care, it can generally be accepted that the assessment and management of paediatric pain is below what would be expected, and compared with with that for adults, it is sub-optimal. Multiple demographic influences are evident and appear to influence clinician decisions.