Research Paper Title
Taking the Pain out of Somatisation: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Paediatric Somatic Symptom and Related Disorders.
The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care.
Little literature exists to address SSRDs in the inpatient paediatric setting.
The purpose of the study was to characterise current SSRD practice, identify problem areas in workflow, and develop a standardised approach to inpatient evaluation and management at a tertiary care academic children’s hospital.
A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014.
A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice.
Lean methodology was used to define current state practice and future state intervention.
These methods were used to guide identification of problem areas, which informed protocol, a clinical practice guideline, and resource development.
Thirty-six patients aged 8 to 17 years met inclusion criteria for chart review.
Most patients presented with either neurological or pain-related complaints.
The mean length of stay was 5.44 days (SD = 6.3), with few patients receiving a mental health consultation within 24 hours of hospitalisation.
Patients averaged 5.8 medical and/or psychiatric diagnoses on discharge (SD = 5.2), and two-thirds did not have an SSRD diagnosis.
Half of patients had co-morbid psychiatric diagnoses, whereas one-quarter were discharged with no mental health follow-up.
In this study, the researchers describe the process and content development of a single-site institutional protocol, clinical practice guideline, and resources for the evaluation and management of paediatric SSRDs.
This study may serve as a model for similar standardisation of SSRD care in other inpatient paediatric medical settings.
Kullgren, K.A., Shefler, A., Malas, N., Monroe, K., Leber, S.M., Sroufe, N., El Sakr, A., Pomeranz, E., O’Brien, E. & Mychaliska, K.P. (2020) Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders. Hospital Paediatrics. 10(2), pp.105-113. doi: 10.1542/hpeds.2019-0141. Epub 2020 Jan 2.