ABSTRACT
Synopsis One of the key aspects of good health care for children and young people is the prevention and management of pain. The experience of persistent pain in children and adolescents not only has a major impact on physical, emotional, social, and developmental well-being, but also impacts the broader world, which includes family, school, and social networks. The multidisciplinary pediatric pain clinic adopts a holistic approach to care through a biopsychosocial model. One outcome of an initial pediatric pain clinic review is the creation of a pain management plan that addresses the pharmacological, physical, psychological, and other domains of care. Pediatric pain clinics are improving access by embracing technology through tele-health and internet-based treatment options. Outcome measurement will guide the development of models of care in the future. J Orthop Sports Phys Ther 2017;47(10):806-813. Epub 12 Sep 2017. doi:10.2519/jospt.2017.7355.
Subject(s)
Chronic Pain/therapy , Pain Clinics/organization & administration , Pain Management , Patient Care Team , Adolescent , Australia/epidemiology , Child , Child, Preschool , Chronic Pain/diagnosis , Chronic Pain/epidemiology , Chronic Pain/psychology , Humans , Infant , Infant, Newborn , Models, Psychological , Outcome Assessment, Health Care , Prevalence , Surveys and Questionnaires , Telemedicine , Tertiary Care Centers/organization & administrationABSTRACT
OBJECTIVE: To compare the incidence of complications with a primary gastrostomy versus gastrostomy with concurrent fundoplication and evaluating the impact of the method of gastrostomy tube placement. Neurologically impaired children were compared with neurologically normal children. Two low profile devices were compared for longevity. METHODS: Ninety-eight patients (58 boys, mean age 4.66 years) with 107 gastrostomies inserted between April 2004 and May 2008 were included in this retrospective, single institution audit. Minimum follow-up period was 1 year. Specific complications reviewed were tube and site related. Logistic regression analysis examined the relationship between complications, type of procedure, method of placement, and neurological status. Survival analysis with log-rank test was used to compare the duration of the low-profile devices. RESULTS: There were 63 primary gastrostomies and 44 with concurrent fundoplication, 71 children were neurologically impaired. Mean (±SD) follow-up time was 35.6â±â1.4 months. There was a significant association between concurrent gastrostomy insertion with fundoplication and incidence of infection (odds ratioâ=â2.4, 95% confidence interval (CI) 1.02-5.56, Pâ=â0.02) and excoriation (odds ratioâ=â2.5, 95% CI 1.09-5.71, Pâ=â0.015). There were no associations between the complications with gastrostomy placement and neurological status. Failure rate of the balloon device was significantly greater than the fixed bolster device with a Hazard Ratio for survival of 3.2 (95% CI 2.2-4.6). CONCLUSIONS: Gastrostomy site-related problems were more common than generally reported. There was a higher incidence of site infection and skin excoriation for gastrostomy placement with concurrent fundoplication. There was no significant difference in complications between the method of gastrostomy placement or neurological status. Balloon devices were changed 3 times more often than bolster retention devices.