| Pain,can bring various short-term and long-term adverse effects on children.The International Association for the Study Pain(IASP)advocates that medical staff should continue to pursue the painless state of patients.However,children's pain management has been unsatisfactory.One of the main factors affecting the quality of children's pain management in China is the lack of guidelines for children's pain management and lack of evidence-based ability in pediatric nurses.Successfully applicate of guidelines can improve scientific decision-making ability,so as to promote patients safety.However,the guidelines or standards for pain management corresponding to children of different ages have not been published in China.There is a misconception in the clinical application of the guidelines.That is,the recommendation of the guide must be correct.As one of the sources of evidence for clinical practice,the quality of the guidelines determines the reliability of recommendations.Thus there is a need to evaluate the quality of guidelines for pediatric pain management,summarize and analyze the consensus of included guidelines' recommendations,so as to provide evidence-based evidence for the clinical practice of children's pain management and provide a reference for the construction of children's pain management guideline in China.Objective: To evaluate the quality of included guidelines for pediatric pain management,analyze and summarize the consensus of those guidelines' recommendations after comprehensive retrieval of existing clinical practice guidelines for children's pain management.Methods:(1)Relative guidelines published internationally from the establishment of database to December 2017 were searched.(2)Then the quality of included guidelines was evaluated using AGREE II,and finally recommended levels of guidelines were given,respectively.Intraclass correlation coefficient was used to test the consistency among the evaluators.(3)All included guidelines were analyzed using content analysis.Determine the unit of analysis based on the topic of the guide,make a data extraction table and a classification system,and classify and file manually.Results:(1)A total of 60 guidelines were retrieved,of which 8 met the inclusion criteria.(2)No A-class guideline was recommended.7 guidelines were leveled as B-class(recommended after revise).1 guideline was not recommended.Average AGREE II scores in six domains(Scope and Purpose,Stakeholder Involvement,Rigor of Development,Clarity of Presentation,Applicability and Editorial Independence)were 81.25%,53.82%,46.88%,76.74%,44.27%,42.19% separately.(3)Finally 8 items related to pain management recommends were identified,including pain assessment,intervention,recording and training etc.There were differences in the specific methods of children's pain assessment and intervention(such as pain assessment tools,non-drug analgesia,etc.),but the basic principles of pain management are consistent.Conclusion: At present,no guidelines or standards for pain management corresponding to children in different age groups have been published yet.However,after rigorous quality evaluation,there are currently seven B-level quality children's pain management guidelines in foreign countries.The eight items involved in the recommendations(common pain-causing procedures,pain expression of children,principles of pain management,participants,pain assessment,pain interventions,records,and training)can serve as the basic framework for the construction of children's pain management guidelines in China.It is recommended to strictly follow the guideline development method,including the rigor and the applicability of the recommendations.Evidence-based medicine approach was adopted to deal with the differences in the recommendations,and the recommended consensus was used as a reference to construct or adapt the children's pain management guidelines in China. |
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