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Child behaviour and pain after hospitalization, surgery and anaesthesia
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
2006 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Hospitalization, surgery and anaesthesia are for some children associated with anxiety and could be a frightful experience which may result in later problematic behaviour. Pain is associated with the fears of hospitalization. The first aim was to investigate how pain in children is treated in Swedish hospitals as well as to assess the results of this treatment. Behaviour after hospitalization has been measured by the Post Hospital Behaviour Questionnaire (PHBQ). A second aim was to translate this instrument into Swedish and to validate it. The third aim was to analyze which factors (sociodemographic back¬ground; earlier experience; events at the hospital) that might be associated with changes in behaviour.

Methods: A questionnaire regarding acute pain, its treatment methods and results of treatments as well as contributing factors to inadequate results, was sent to all departments in hospitals that might treat children. One form was answered by phy¬sicians and another form by nurses.

In the second part of the study, a cohort of 340 children ages 2-13 were followed from two weeks before hospitalization until two weeks after. Data regarding socio¬demography and earlier health care experience were collected. The Child Behav¬iour Checklist was issued before and after hospitalization, the PHBQ was issued after. During hospitalization staff and parents assessed anxiety, pain and nausea mainly by VAS and Likert scales, (parents assessed own and child emotions). Children, older than 4-5 years of age, assessed their own pain using a faces scale.

Results: Despite treatment, moderate to severe pain occurred postoperatively in 23% of patients and in 31% of patients with pain of other origin. Postoperative pain seemed to be a greater problem in units where children were treated together with adults and in departments where fewer children were treated. Pain could often or always be treated more efficiently according to 45% of physi¬cians and nurses. Of all departments, pain assessments were performed regularly in 43%, but pain measurement was less frequent. Opioids were never or infrequently used by 15 %.

A five factor model fitted data better than the original 6 factor model when confir¬mative factor analyse was performed. Cronbach’s alpha was adequate for factors and excellent for the total score (0.92). Risk factors for increased problematic be¬haviour included the following: age less than 5 years of age, living in a one adult family, anxiety at anaesthesia induction, nausea at hospital and pain at home. Liv¬ing in a rural area and midazolam in premedication seem to be protective.

Conclusions: Acute pain in children is still a problem. Inadequate pain treatment is mainly associated with organisational factors (missing prescriptions; a low rate of pain assessments). The PHBQ in Swedish translation is a reliable instrument and its relation to CBCL warrants its further use in research and quality control espe¬cially in younger children. Hospital-induced stress in older children needs further investigation. One third of the children who have been hospitalized and exposed to anaesthesia will have in¬creased problematic behaviour when returning home. Pro¬active interventions are suggested to prevent this by improving pain treatment at home.

sted, utgiver, år, opplag, sider
Umeå: Medicinsk fakultet , 2006. , s. 69
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1062
Emneord [en]
child behaviour, pain, validation, child, hospitalised, pain prevalence, factor analysis, risk factors
HSV kategori
Identifikatorer
URN: urn:nbn:se:umu:diva-917ISBN: 91-7264-185-1 (tryckt)OAI: oai:DiVA.org:umu-917DiVA, id: diva2:145040
Disputas
2006-11-25, B, Tandläkarhögskolan, Universitessjukhuset, Umeå, 10:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2006-11-08 Laget: 2006-11-08 Sist oppdatert: 2011-04-08bibliografisk kontrollert
Delarbeid
1. Acute and postoperative pain in children: a Swedish nationwide survey
Åpne denne publikasjonen i ny fane eller vindu >>Acute and postoperative pain in children: a Swedish nationwide survey
2002 (engelsk)Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 91, nr 6, s. 660-666Artikkel i tidsskrift (Fagfellevurdert) Published
Identifikatorer
urn:nbn:se:umu:diva-5504 (URN)10.1111/j.1651-2227.2002.tb03298.x (DOI)12162598 (PubMedID)
Tilgjengelig fra: 2006-11-08 Laget: 2006-11-08 Sist oppdatert: 2017-12-14bibliografisk kontrollert
2. Behavioural changes after anaesthesia: validity and liability of the Post Hospitalization Behavior Questionnaire in a Swedish paediatric population.
Åpne denne publikasjonen i ny fane eller vindu >>Behavioural changes after anaesthesia: validity and liability of the Post Hospitalization Behavior Questionnaire in a Swedish paediatric population.
2006 (engelsk)Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, nr 3, s. 340-346Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

AIM: To study the validity and liability of a Swedish translation of the Post Hospitalization Behavior Questionnaire (PHBQ) in children in Sweden. METHODS: The PHBQ was translated using a back-translation method. The subjects were 340 children, ages 2-13 y, admitted for elective surgery or diagnostic procedure with anaesthesia. The results were analysed using exploratory factor analysis with principal component analysis with Oblimin rotation. The fit to data was examined using confirmative factor analysis with a good measure of fit for the model (p>0.09 for all factors). RESULTS: Five factors emerged as being most consistent: general anxiety-withdrawal, eating disturbances, separation anxiety, regression-aggression and sleep anxiety. A panel of child psychologists confirmed the face validity of factors. Internal consistency (Chronbach's alpha) was adequate (0.75-0.87) for subscales and excellent for total score (0.93). Children less than 5 y old had higher scores than older children (mean 0.046+/-0.018 vs -0.0089+/-0.014, p<0.001). There were no gender differences. CONCLUSION: The results support a conclusion that a five-factor model better fits data from Swedish children than the original six-factor model.

Emneord
Adolescent, Adolescent Behavior, Age Factors, Anesthesia/*psychology, Child, Child Behavior, Child; Preschool, Female, Hospitalization, Humans, Male, Psychometrics, Questionnaires, Reproducibility of Results, Sex Factors, Surgical Procedures; Elective/*psychology, Sweden
Identifikatorer
urn:nbn:se:umu:diva-13896 (URN)10.1080/08035250500434751 (DOI)16497646 (PubMedID)
Tilgjengelig fra: 2007-12-18 Laget: 2007-12-18 Sist oppdatert: 2018-06-09bibliografisk kontrollert
3. Behavioural changes after anaesthesia: association of socioeconomic factors and child behaviour checklist to the post hospital behaviour questionnaire
Åpne denne publikasjonen i ny fane eller vindu >>Behavioural changes after anaesthesia: association of socioeconomic factors and child behaviour checklist to the post hospital behaviour questionnaire
(engelsk)Manuskript (Annet vitenskapelig)
Identifikatorer
urn:nbn:se:umu:diva-5506 (URN)
Tilgjengelig fra: 2006-11-08 Laget: 2006-11-08 Sist oppdatert: 2018-06-09bibliografisk kontrollert
4. Child behaviour after anaesthesia: associated risk factors
Åpne denne publikasjonen i ny fane eller vindu >>Child behaviour after anaesthesia: associated risk factors
(engelsk)Manuskript (Annet vitenskapelig)
Identifikatorer
urn:nbn:se:umu:diva-5507 (URN)
Tilgjengelig fra: 2006-11-08 Laget: 2006-11-08 Sist oppdatert: 2018-06-09bibliografisk kontrollert

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