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Burns. 2014 Dec;40(8):1463-9. doi: 10.1016/j.burns.2014.08.020. Epub 2014 Sep 29.

Acute pain management in burn patients: appraisal and thematic analysis of four clinical guidelines.

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Department of Anesthesiology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark. Electronic address:
Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.
Department of Anesthesiology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.
Faculty of Health & Medical Sciences, University of Copenhagen, Denmark; Trauma Centre, Copenhagen University Hospital Rigshospitalet, Denmark.



Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units.


The study had a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II, and identified core themes in the guidelines.


The overall scores expressing quality in six domains of the AGREE instrument were variable at 22% (DK), 44% (SE), 100% (NZ), and 78% (USA). The guidelines from NZ and USA were highly recommended, the Swedish was recommended, whereas the Danish was not recommended. The identified core themes were: continuous pain, procedural pain, postoperative pain, pain assessment, anxiety, and non-pharmacological interventions.


The study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes.


AGREE instrument; Burns; Clinical guidelines; Pain management; Pediatrics

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