الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Pain is defined as ””an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (Gorczyca et al., 2013). Numerous illnesses are accompanied with pain, and each of these disorders creates distinct/separate diagnostic, therapeutic, and research challenges. One of the most incapacitating, bothersome, and expensive conditions, pain is the most common cause for individuals to seek medical attention (Gorczyca et al., 2013). Our study is a cross sectional, cohort, prospective, observational one. This study is conducted on 68 cases admitted in Pediatric Intensive Care Unit (PICU) in Mansoura University Children Hospital (MUCH) over a period of one year from April 2021 to April2022.The aim of our study is to assess pain level in children admitted to intensive care unit (PICU) using three pain scales which are the FLACC, CPOT and COMFORT scales during rest and during procedures, to assess the reliability and validity of the pain scores used to assess the pain level and to see the possibility to predict the prognosis of children admitted in PICU according to the scores of each pain scale. The vast majority of children admitted to the PICU in this survey were females (52.9%) with a median age of 3.5 years. In our research, the most prevalent reason for PICU hospitalization was due to pulmonary disorders (39.7%). The two other major diagnoses were cardiac diseases and DKA (both 12%) , followed by 25% of cases diagnosed with other disorders (e.g., CKD, SLE, Kawasaki, aplastic anemia, meningitis, septic shock with AKI, and post-covid MISC). The use of behavioral pain tools might very well aid in the evaluation of pain in critically ill patients, but the tools would have to be reliable and valid, as well as clinically feasible (the potential to adapt a tool easily and quickly for evaluation and documentation). Clinical feasibility may rely on a tool’s clarity and integration with other tools applied in the healthcare setting, along with being able to use the tool throughout situations or different groups of patients (Voepel-Lewis et al., 2010). All scales were discovered to be pain sensitive, as evidenced by a significant rise in scores over phases (at rest to during procedures). All of the three scales showed good reliability even in intubated sedated patients. The drug of first choice for sedation purposes in our PICU is midazolam (dose of 0.15 mg/kg/dose IV or 1-2 mcg /kg/min if continuous IVI).). When sedation is considered insufficient, fentanyl is given in addition to midazolam. In our study, the patients were unfortunately under-sedated proved by the median score of COMFORT scale particularly, but also the median scores of both FLACC, CPOT scales. In our study, the COMFORT scale was proven to be a good tool for evaluating sedation in the patients admitted to the PICU. In our study, we aimed to search for the prognosis of children admitted to PICU with the help of the three pain scales. In case of FLACC and CPOT scores ≤5, mortality rates were higher suggesting the possibility that pre-terminal children exhibit lower pain scales. In case of FLACC scale, score ≤ 5 can discriminate non-survivors from survivors with 100% sensitivity and 65.5% specificity. Regarding the COMFORT scale if the score ≤27, mortality rates were higher and its ability to discriminate non-survivors from survivors with 90% sensitivity and 56.9% specificity. In case of CPOT scale, it is able to discriminate non-survivors from survivors with 100% sensitivity and 56.9% specificity. Another fascinating observation in our study was that the younger the age, the higher the mortality rate, with 20% mortality rates in those younger than 42 months of age compared to just 9% in those older than 42 months of age. Cardiac patients seemed to have the greatest fatality rates (41%), followed by pulmonary patients (11%). In terms of the ages of the deceased children, the mean age in our research was less than 42 months.