We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: ‘child sex (male)’, ‘child age (younger)’, ‘type of pain (traumatic)’ and ‘analgesic administration’. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child’s experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child.


University of Lincoln, College of Social Science Research

Gregory A Whitley, University of Lincoln, Community and Health Research Unit and School of Health and Social Care

Pippa Hemingway, University of Nottingham, Faculty of Medicine and Health Sciences

Graham R Law, University of Lincoln, Community and Health Research Unit and School of Health and Social Care

Arwel W Jones, Monash University, Department of Allergy, Immunology and Respiratory Medicine
Ffion Curtis, University of Lincoln, Community and Health Research Unit and School of Health and Social Care
Niro Siriwardena, University of Lincoln, Community and Health Research Unit and School of Health and Social Care