Cross-sectional evolution of pain management policies and practices in Portuguese pediatric emergency departments

The prevalence of pediatric pain, either related to the child’s hospital visit or as a result of diagnostic and/or therapeutical interventions, is of primordial importance in pediatric emergency departments (PEDs). In this study, we evaluate the evolution of pain assessment and management in Portuguese PEDs through eleven years. To this end, we prepared a questionnaire addressed to head physicians of 45 the Portuguese PEDs in 2007 and compared the responses to those provided in 2018, where we also posed these questions to nurse managers. Pain assessment in Portuguese PEDs has significantly improved, namely with establishment of local protocols and widespread use of pain scales. However, effective adoption of pain management remains insufficient, as mild to moderate pain is still far from being universally treated. Nonetheless, there seems to be an adequate treatment of severe pain and respective common use of opioids, but correct practices were not generally adopted when specific types of pain were analyzed. Procedural sedation and use of non-pharmacological techniques has significantly increased, but are not yet universally practiced. These inadequacies are reflected by the staff’s perception that pain management remains suboptimal, and more training is needed, effectively urging for a nationwide plan and better knowledge translation of correct pediatric pain management. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present work are contained in the manuscript