A visual guideline for severe burn pain care at a Canadian pediatric referral center

Introduction

Severe pediatric burns (involving >25% of total body surface area) present unique challenges in pain management, with need of supporting comfort without over-sedating and daily multidisciplinary collaboration. We aimed to create a consensus-based, easily accessible guideline for standardizing clinical management of severe burn pain at the British Columbia Children’s Hospital (BCCH) in Vancouver.

Methods

Using information from a review of the current literature and regional practice guidelines at other centers, we built upon existing material at BCCH to produce a visual guideline in the format of a flowchart. We consulted key specialist providers to align with actual institutional practices and then sought feedback from a wider group of physicians regarding practical implementation. Work is ongoing to disseminate the guideline via a clinical resources portal at BCCH for integration into multidisciplinary practice.

Results

We referenced three main practice guidelines from other centers to build upon existing guidance material at BCCH.[1-3] Themes that emerged include management of background discomfort, breakthrough pain, and procedure-related pain, as well as co-management of agitation and delirium. This guideline could form part of a daily review to standardize and optimize team-based practice in managing pain and supporting comfort in severe burn patients.

References

[1] Upex A. Clinical guideline: Burn pain management in paediatrics [Internet]. Bristol (UK): Bristol Royal Hospital for Children. Available from: https://uhbw.mystaffapp.org/diliboards/82/diliboard_contents/765/document_view.pdf 

[2] Paediatric burns service guidelines [Internet]. Adelaide (AU): Women's and Children's Hospital, South Australia; April 2023. Available from: https://cdn.wchn.sa.gov.au/downloads/WCH/children/burns/Paediatric-Burns-Service-Guidelines.pdf

[3] Perth Children's Hospital. Burns - Analgesia and dosing [Internet]. Perth (AU): Perth Children's Hospital; Nov 2024. Available from: https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Burns-Analgesia-and-dosing