Jori F Bogetz, Megan Phan, Elsa Ayala, Yasmeen Alayli, Emily E Johnston, Prasanna Ananth, Julie McGalliard, Bryan Strub, Miranda C Bradford, Abby R Rosenberg
{"title":"患有复杂慢性疾病的儿童临终时疼痛发作的差异。","authors":"Jori F Bogetz, Megan Phan, Elsa Ayala, Yasmeen Alayli, Emily E Johnston, Prasanna Ananth, Julie McGalliard, Bryan Strub, Miranda C Bradford, Abby R Rosenberg","doi":"10.1016/j.jpainsymman.2025.09.015","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study examined disparities in pain episodes at end-of-life (EOL) among children with complex chronic conditions (CCCs).</p><p><strong>Methods: </strong>This was a retrospective study of children and young adults ages 0-25 years who died in-hospital at a U.S. academic institution between January 2021-December 2024. Demographic data and pain scores (0=no pain to 10=worst pain) from the electronic health record were automatically abstracted. Exploratory analyses included descriptive statistics and Pearson's chi square tests.</p><p><strong>Results: </strong>Among 482 children, 50% (n=243) were infants, 31% (n=148) were children 1-12 years, 13% (n=62) were adolescents 13-17 years, and 6% (n=29) were young adults ≥18 years. 55% (n=264) were male, 47% (n=202) were white, 18% (n=88) were Hispanic, and 18% (n=81) preferred a language other than English. 70% (n=339) had congenital/genetic, neurologic/neuromuscular, and/or metabolic CCCs; 22% (n=104) had malignancy; 22% (n=107) had hematologic/immunologic CCCs; and 16% (n=78) had respiratory CCCs. 87% (n=420) died in the intensive care unit (ICU). In the last 3 days of life, 60% (n=276) had at least one moderate-to-severe pain score ≥4 and, of those, 32% (n=148) had at least one severe pain score ≥7. We observed a higher proportion of children with severe pain episodes among adolescents/young adults, Hispanics, those who preferred a language other than English, those with malignancy, hematologic/immunologic, and respiratory CCCs, and those who died in the ICU.</p><p><strong>Conclusion: </strong>Moderate-to-severe pain episodes were present in >50% of children with CCCs in the last 3 days of life. The proportion differed based on demographic factors reflecting known health disparities.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Differences in pain episodes among children with complex chronic conditions at end of life.\",\"authors\":\"Jori F Bogetz, Megan Phan, Elsa Ayala, Yasmeen Alayli, Emily E Johnston, Prasanna Ananth, Julie McGalliard, Bryan Strub, Miranda C Bradford, Abby R Rosenberg\",\"doi\":\"10.1016/j.jpainsymman.2025.09.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study examined disparities in pain episodes at end-of-life (EOL) among children with complex chronic conditions (CCCs).</p><p><strong>Methods: </strong>This was a retrospective study of children and young adults ages 0-25 years who died in-hospital at a U.S. academic institution between January 2021-December 2024. Demographic data and pain scores (0=no pain to 10=worst pain) from the electronic health record were automatically abstracted. Exploratory analyses included descriptive statistics and Pearson's chi square tests.</p><p><strong>Results: </strong>Among 482 children, 50% (n=243) were infants, 31% (n=148) were children 1-12 years, 13% (n=62) were adolescents 13-17 years, and 6% (n=29) were young adults ≥18 years. 55% (n=264) were male, 47% (n=202) were white, 18% (n=88) were Hispanic, and 18% (n=81) preferred a language other than English. 70% (n=339) had congenital/genetic, neurologic/neuromuscular, and/or metabolic CCCs; 22% (n=104) had malignancy; 22% (n=107) had hematologic/immunologic CCCs; and 16% (n=78) had respiratory CCCs. 87% (n=420) died in the intensive care unit (ICU). In the last 3 days of life, 60% (n=276) had at least one moderate-to-severe pain score ≥4 and, of those, 32% (n=148) had at least one severe pain score ≥7. We observed a higher proportion of children with severe pain episodes among adolescents/young adults, Hispanics, those who preferred a language other than English, those with malignancy, hematologic/immunologic, and respiratory CCCs, and those who died in the ICU.</p><p><strong>Conclusion: </strong>Moderate-to-severe pain episodes were present in >50% of children with CCCs in the last 3 days of life. The proportion differed based on demographic factors reflecting known health disparities.</p>\",\"PeriodicalId\":16634,\"journal\":{\"name\":\"Journal of pain and symptom management\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of pain and symptom management\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jpainsymman.2025.09.015\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpainsymman.2025.09.015","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Differences in pain episodes among children with complex chronic conditions at end of life.
Objective: This study examined disparities in pain episodes at end-of-life (EOL) among children with complex chronic conditions (CCCs).
Methods: This was a retrospective study of children and young adults ages 0-25 years who died in-hospital at a U.S. academic institution between January 2021-December 2024. Demographic data and pain scores (0=no pain to 10=worst pain) from the electronic health record were automatically abstracted. Exploratory analyses included descriptive statistics and Pearson's chi square tests.
Results: Among 482 children, 50% (n=243) were infants, 31% (n=148) were children 1-12 years, 13% (n=62) were adolescents 13-17 years, and 6% (n=29) were young adults ≥18 years. 55% (n=264) were male, 47% (n=202) were white, 18% (n=88) were Hispanic, and 18% (n=81) preferred a language other than English. 70% (n=339) had congenital/genetic, neurologic/neuromuscular, and/or metabolic CCCs; 22% (n=104) had malignancy; 22% (n=107) had hematologic/immunologic CCCs; and 16% (n=78) had respiratory CCCs. 87% (n=420) died in the intensive care unit (ICU). In the last 3 days of life, 60% (n=276) had at least one moderate-to-severe pain score ≥4 and, of those, 32% (n=148) had at least one severe pain score ≥7. We observed a higher proportion of children with severe pain episodes among adolescents/young adults, Hispanics, those who preferred a language other than English, those with malignancy, hematologic/immunologic, and respiratory CCCs, and those who died in the ICU.
Conclusion: Moderate-to-severe pain episodes were present in >50% of children with CCCs in the last 3 days of life. The proportion differed based on demographic factors reflecting known health disparities.
期刊介绍:
The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.