Pediatrics · 2 h ago
Realist evaluation identifies priorities for children’s prehospital pain care
A realist evaluation in England combined interviews and creative accounts from 44 children, carers and ambulance clinicians with 34,068 ambulance records. The resulting programme theory highlights clinician preparedness, compassionate communication, family involvement, and pain assessment and treatment as areas to address; it has not yet been tested as an intervention.
- Study combined interviews with 34,068 ambulance records.
- Clinician preparedness and compassionate care were key themes.
- Parents’ involvement and anxiety were highlighted.
- Programme theory needs empirical testing.
Researchers used a multiple-case realist evaluation to refine a programme theory for managing acute pain in children and young people attended by ambulance. Participants were children aged 4–17 years, their parents or carers, and ambulance clinicians recruited through services and children’s emergency departments in England between August 2024 and July 2025. The analysis also included routine clinical records from two ambulance services covering January 2021 to December 2023.
The study recruited 21 ambulance clinicians, 14 parents or carers and nine children and young people, generating 41 interview transcripts, two pieces of artwork and one diary. Researchers also analysed 34,068 clinical records. The refined theory emphasised clinician education, training and experience; private, reassuring and person-centred care; building trust and empowering children; and involving parents while addressing their fear and anxiety. Pain assessment and treatment considerations included covering visible signs of injury or illness, using distractions such as stickers, meeting expectations and recognising how catastrophising may affect assessment.
The findings offer a framework for developing future interventions, rather than evidence that any specific approach improves pain outcomes. The authors say the programme theory requires empirical testing. The study was conducted in England, and the reported themes should not be interpreted as proof of intervention effectiveness.
In practice
For ambulance clinicians caring for children and young people with acute pain, the findings identify potentially useful care priorities: prepare through education and experience, provide calm and reassuring person-centred care, involve parents, and consider non-pharmacological distraction alongside pain assessment and treatment. These are themes from a realist evaluation, not evidence that a defined intervention improves pain outcomes. The programme theory has not yet been empirically tested, so the study alone does not establish that practice changes based on these findings will improve care.
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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine: What works well for children and young people suffering acute pain attended by ambulance? A realist evaluation ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.