Design and adaptation of a practice guideline for nonpharmacological management of pain in injured children in emergency medical services

J Educ Health Promot. 2026 Mar 31;15:103. doi: 10.4103/jehp.jehp_1905_24. eCollection 2026.

ABSTRACT

BACKGROUND: Pain is one of the most common complaints among children in emergency medical services (EMSs). Unfortunately, it is often inadequately and poorly managed, resulting in unnecessary pain and suffering in pediatric populations. Given the barriers to pharmacological pain management for children in prehospital emergency settings, emergency medical technicians can effectively utilize nonpharmacological approaches to pain management without fear or concern. Practice guidelines are one of the effective factors in optimizing pain management for children in the prehospital setting. This study aimed to design and localize a clinical guideline for nonpharmacological pain management in injured children in EMSs.

MATERIALS AND METHODS: Through a multistage evolutionary study conducted from April 2020 to February 2022, practice guidelines relevant to the research topic were extracted from databases and evaluated and critiqued using the Appraisal of Guidelines for Research and Evaluation (AGREE) tool for guideline quality. The two selected practice guidelines with the highest scores were used to extract clinical recommendations, which were then synthesized into a localized clinical guideline after consensus in two Delphi rounds and a panel of experts.

RESULTS: The recommendations were categorized into three sections: general recommendations (9 recommendations), pain assessment and measurement (10 recommendations), and nonpharmacological management (15 recommendations). These recommendations were extracted from two selected clinical guidelines, which were filtered from six guidelines after AGREE evaluation. After consensus among experts in two Delphi rounds, the recommendations were compiled into a localized clinical guideline.

CONCLUSION: The clinical guideline for prehospital pain management in injured children can improve the quality-of-care programs, address existing barriers to pain management in children, and increase patient satisfaction. The developed guidelines are also used in the evaluation of emergency services' performance in pain management and the accreditation of prehospital care. Future research should investigate the prevalence and management of pediatric pain in prehospital settings, outcome measures, barriers, and facilitating factors in this area.

PMID:42016399 | PMC:PMC13094903 | DOI:10.4103/jehp.jehp_1905_24