improving Pain mAnagement for childreN and young people attendeD by Ambulance (PANDA): a realist review.

  

Background: Each year in England approximately 90,000 children and young people (CYP) under 18 years of age are transported by ambulance to emergency departments with acute pain. The intersection between acute pain, unwell CYP and the unpredictable prehospital environment is highly convoluted. Studies demonstrate that prehospital pain management in CYP is poor, with 61% of those suffering acute pain not achieving effective pain relief. The consequences of this can include post-traumatic stress disorder and the development of chronic pain. The aim of this realist review was to enhance our understanding of what works best to improve prehospital acute pain management in CYP.

Methods: A realist review was conducted in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. A five-stage approach was adopted: 1) Develop an Initial Programme Theory (IPT) with key stakeholder input and evidence from informal searching; 2) Searching and screening of relevant research databases and grey literature sources, in duplicate; 3) Document selection – assess documents for relevance and rigour, in duplicate; 4) Extracting and organising data – code relevant data into conceptual topics using NVivo software; and 5) Synthesis and Programme Theory (PT) refinement using a realist logic of analysis to generate context-mechanism-outcome configurations (CMOCs) within and across conceptual topics to test and refine the IPT into a realist PT.

Results: From 1503 documents screened, 95 were included, representing journal articles, theses, book chapters and clinical practice guidelines. Conceptual topics developed include ambulance clinician preparedness, expectations, analgesic administration, nonpharmacological treatment, and fear and anxiety of CYP. Step four and five are currently ongoing. We anticipate the development of several CMOCs that will underpin a realist PT.

Conclusion: The realist PT will be tested and refined within a realist evaluation, which will collect primary data through interviews, diaries, arts-based methods and electronic messaging. 

Registration: PROSPERO - CRD42024505978