• Maleea D Holbert, Roy M Kimble, Lee V Jones, Samiul H Ahmed, and Bronwyn R Griffin.
• Centre for Children's Burns and Trauma Research, Queensland Health Centre for Children's Health Research, South Brisbane, Queensland, Australia m.holbert@uq.edu.au.
• Reg Anesth Pain Med. 2021 Mar 1; 46 (3): 222-227.

IntroductionThere is an absence of evidence regarding predictors of moderate to severe pain in children undergoing acute burn treatment. This investigation aimed to determine if relationships existed between patient and clinical characteristics, and pain at first dressing change for children with acute burn injuries.MethodsA retrospective cohort investigation was conducted using clinical data from pediatric burn patients treated at the Queensland Children's Hospital, Brisbane, Australia. Data extracted included patient and burn characteristics, first aid, and follow-up care. Observational pain scores were categorized into three groups (mild, moderate, and severe pain), and bivariate and multivariable relationships were examined using proportional odds ordinal logistic regression. Data from 2013 pediatric burns patients were extracted from the database.ResultsFactors associated with increased odds of procedural pain included: hand burns (OR 1.7, 95% CI 1.3 to 2.1, p<0.001), foot burns (OR 1.5, 95% CI 1.1 to 2.1, p<0.01), baseline pain (OR 5.5, 95% CI 2.8 to 10.8, p<0.001), deep dermal partial-thickness injuries (OR 7.9, 95% CI 4.0 to 15.6, p<0.001), increased burn size (OR 1.1, 95% CI 1.0 to 1.2, p<0.01), four or more anatomical regions burned (OR 3.6, 95% CI 1.5 to 8.6, p<0.01), initial treatment at a non-burns center (OR 1.8, 95% CI 1.4 to 2.3, p<0.001), and time to hospital presentation (OR 0.9, 95% CI 0.8 to 0.9, p<0.001). These burn characteristics are associated with increased odds of moderate to severe procedural pain during a child's first dressings change.DiscussionIt is recommended that patients presenting with one or more of the aforementioned factors are identified before their first dressing change, so additional pain control methods can be implemented.© American Society of Regional Anesthesia & Pain Medicine 2021. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

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