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

Georgie Nicholls; Georgette Eaton; Marishona Ortega; Kacper Sumera; Michael Baliousis; Jessica Hodgson; Despina Laparidou; Aloysius Niroshan Siriwardena; Paul Leighton; Sarah Redsell; Bill Lord; Tatiana Bujor; Gregory Adam Whitley

doi:10.3310/nihropenres.13627.2

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

NIHR Open Res. 2024 Sep 5:4:42. doi: 10.3310/nihropenres.13627.2. eCollection 2024.

Authors

Georgie Nicholls¹, Georgette Eaton^{2

3}, Marishona Ortega⁴, Kacper Sumera⁵, Michael Baliousis^{6

7}, Jessica Hodgson⁸, Despina Laparidou¹, Aloysius Niroshan Siriwardena¹, Paul Leighton⁹, Sarah Redsell¹⁰, Bill Lord¹¹, Tatiana Bujor¹², Gregory Adam Whitley^{1

13}

Affiliations

¹ Community and Health Research Unit, University of Lincoln, Lincoln, England, LN6 7FS, UK.
² London Ambulance Service NHS Trust, London, England, SE1 8SD, UK.
³ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, OX2 6GG, UK.
⁴ Libraries and Learning Skills, University of Lincoln, Lincoln, England, LN6 7TS, UK.
⁵ East Midlands Ambulance Service NHS Trust, Nottingham, England, NG8 6PY, UK.
⁶ School of Psychology, University of Lincoln, Lincoln, England, LN5 7TS, UK.
⁷ Nottingham University Hospitals NHS Trust, Nottingham, England, NG5 1PB, UK.
⁸ School of Medicine, University of Nottingham, Nottingham, England, NG7 2RD, UK.
⁹ Applied Health Research Building (Building 42), University of Nottingham, Nottingham, England, NG7 2RD, UK.
¹⁰ Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, England, NG7 2UH, UK.
¹¹ Monash University, Clayton, Victoria, Australia.
¹² The Medical School, Newcastle University, Newcastle upon Tyne, England, NE2 4HH, UK.
¹³ Clinical Audit and Research Unit, East Midlands Ambulance Service NHS Trust, Lincoln, England, LN4 2HL, UK.

Abstract

Background: Each year in England, 450,000 children and young people (CYP) under 18 years of age are transported by ambulance to emergency departments. Approximately 20% of these suffer acute pain caused by illness or injury. Pain is a highly complex sensory and emotional experience. The intersection between acute pain, unwell CYP and the unpredictable pre-hospital environment is convoluted. Studies have shown that prehospital pain management in CYP is poor, with 61% of those suffering acute pain not achieving effective pain relief (abolition or reduction of pain score by 2 or more out of 10) when attended by ambulance. Consequences of poor acute pain management include altered pain perception, post-traumatic stress disorder and the development of chronic pain. This realist review will aim to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP.

Methods: A realist review will be conducted in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. A five-stage approach will be adopted; 1) Developing an Initial Programme Theory (IPT): develop an IPT with key stakeholder input and evidence from informal searching; 2) Searching and screening: conduct a thorough search of relevant research databases and other literature sources and perform screening in duplicate; 3) Relevance and rigour assessment: assess documents for relevance and rigour in duplicate; 4) Extracting and organising data: code relevant data into conceptual "buckets" using qualitative data analysis software; and 5) Synthesis and Programme Theory (PT) refinement: utilise a realist logic of analysis to generate context-mechanism-outcome configurations (CMOCs) within and across conceptual "buckets", test and refine the IPT into a realist PT.

Conclusion: The realist PT will enhance our understanding of what works best to improve acute prehospital pain management in CYP, which will then be tested and refined within a realist evaluation.

Registration: PROSPERO Registration: CRD42024505978.

Keywords: Acute Pain; Analgesia; Child; Emergency Medical Services; Paediatrics; Paramedics.

Grants and funding

This project is funded by the National Institute for Health and Care Research (NIHR) under its [HEE/NIHR Integrated Clinical Academic Programme awarded to Gregory Adam Whitley (Grant Reference Number NIHR302875)]. The views expressed are those of the author(s) and not necessarily those of the NIHR, NHS or the Department of Health and Social Care. Georgie Nicholls was funded by the Advanced Clinical and Practitioner Academic Fellowship [NIHR302875]. Tatiana Bujor received reimbursement for involvement in line with NIHR INVOLVE rates, funded by the Advanced Clinical and Practitioner Academic Fellowship [NIHR302875].