improving Pain mAnagement for childreN and young people attendeD by Ambulance (PANDA): protocol for a realist review [version 1; peer review: 2 approved with reservations]

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

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 grey literature sources and perform screening in duplicate; 3) Document selection – 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

Citation

Nicholls, G., Eaton, G., Ortega, M., Sumera, K., Baliousis, M., Hodgson, J., Laparidou, D., Siriwardena, A. N., Leighton, P., Redsell, S., Lord, B., Bujor, T., & Whitley, G. A. (2024). improving Pain mAnagement for childreN and young people attendeD by Ambulance (PANDA): protocol for a realist review [version 1; peer review: 2 approved with reservations]. NIHR Open Research, 4, Article 42. https://doi.org/10.3310/nihropenres.13627.1

• Journal Article Type: Article
• Acceptance Date: Jul 31, 2024
• Online Publication Date: Jul 23, 2024
• Publication Date: Jul 23, 2024
• Deposit Date: Jul 25, 2024
• Publicly Available Date: Jul 25, 2024
• Journal: NIHR Open Research
• Print ISSN: 2633-4402
• Publisher: F1000Research
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Article Number: 42
• DOI: https://doi.org/10.3310/nihropenres.13627.1
• Public URL: https://nottingham-repository.worktribe.com/output/37599687
• Publisher URL: https://openresearch.nihr.ac.uk/articles/4-42/v1
• Additional Information: Referee status: Awaiting Peer Review; Grant Information: 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]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.; Copyright: This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.