How is the return home of children after surgery? With the necessary generalization of outpatient practices, the issue of pain for young patients once they return home is a matter of medical concern. The particularity of pediatrics and the contribution of new technologies allow today to provide a complementary analysis rich in lessons.
To better assess the duration and severity of pain, three doctors from Nice, doctors François de la Brière, Yannick Walrave (anesthetists-resuscitators) and Olivier Rosello (pediatric orthopedic surgeon) launched the idea 6 years ago, to study this. phenomenon by strengthening the connection with families through the Link4Life application in the 10 days following the operation. In 2016 the doctors founded the Link4Life company, its development is supported by the Departmental Council of the Maritime Alps and the Lenval Foundation, allowing the launch of this study in 2019.
“We have decided to optimize exchanges between healthcare professionals and families through a mobile application. This tool allows great responsiveness and is the subject of research work to improve care in surgery.explains Dr. François de la Brière, head of the anesthesia department of the children’s hospitals of Nice CHU – Lenval. To obtain a representative panel essential to carry out our work, we contacted other pediatric institutes through the ADARPEF (Association des Anesthésistes-Réanimateurs Pédiatriques d’Expression Française, ed). Twelve centers took part and nearly 800 parents used the app. “
Very concretely, upon leaving the hospital, families were invited to download Link4life (for free). They entered the required data (temperature, nausea, medication intake, etc.) into the schedule. Depending on the answers, the algorithm could activate a warning for caregivers (for example in the case of an abnormal parameter) and at the same time provide advice to parents (such as “can you give a painkiller”). This responds to a twofold need: that of the caregivers to know how the young patient is and that of the parents to be “followed”.
The child cannot verbalize the pain
The research team looked at factors that could explain why there is more post-operative pain. Among these is age. “In reality it is related to the ability to verbalize. When parents evaluate it, the pain is less than when the little ones express it themselves. A child between 0 and 2 years cannot verbalize it, a child between 2 and 4 years expresses a very distinct feeling (it is not “badly bad” or it is “very very bad”), a child between 4 and 6 years can express nuances: little, medium, a lot. ”
“Over the age of 6, we can assume that they know how to express and evaluate their feelings from 0 to 10″, describes the doctor. In addition, we have noticed that some types of surgery, visceral in particular, hurt more. ” And Doctor de la Brière to specify it “The work highlighted the fact that in anxious families the experience is more painful. We can therefore imagine again adapting some practices to this factor.”
Advice provided through the app
Other indicators found by Link4Life include nausea and vomiting in 10% of patients. Families do not always know what to do, but it is possible to guide them by giving them simple advice, through the notifications on the app, how to administer sugar water, popsicles or even anti-inflammatories that reduce these symptoms and therefore improve the post-operative experience.
This study was published in the famous journal Bread. “We must consider in medical practices an approach that is personalized and pragmatic, strong on this observation, while continuing to develop tools adapted to children under the age of 6. This is our ambition today, a pain scale in pediatrics integrated into a digital tool that facilitates interactions. This project concretely illustrates the importance of funding pediatric research. “