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Parents and practitioners are poor judges of young children's pain severity
Adam J Singer1, Janet Gulla, Henry C Thode
1Department of Emergency Medicine, University Hospital and Medical Center, State University of New York, Stony Brook, NY, USA. adam.singer@sunysb.edu
Insights
Pain assessments in young children show poor agreement between child, parent, and practitioner reports. This study highlights challenges in accurately measuring acute pain severity in pediatric patients using different scales.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Clinical Assessment
Background:
- Accurate pain assessment in young children (4-7 years) with acute pain is challenging.
- Existing pain scales are often validated for older populations, necessitating research into reliable methods for pediatric patients.
- Parental and practitioner assessments are frequently used when direct patient self-report is unreliable.
Purpose of the Study:
- To correlate pain severity ratings between young children, their parents, and healthcare practitioners.
- To evaluate the agreement between different pain assessment methods in a pediatric emergency department setting.
- To determine the most reliable method for assessing acute pain in children aged 4-7 years.
Main Methods:
- Prospective, descriptive study of 63 emergency department patients aged 4-7 years with acute pain.
- Children used a validated five-face ordinal scale (0-4); parents and practitioners used a 100-mm visual analog scale (VAS).
- Pairwise correlations were calculated using Spearman's or Pearson's tests; chi-squared tests assessed categorical data associations.
Main Results:
- Correlation between child and parent pain scores was moderate (0.47, p < 0.001).
- Correlation between child and practitioner pain scores was weak (0.08, p = 0.54).
- Correlation between parent and practitioner pain scores was very weak (0.04, p = 0.001).
Conclusions:
- There is poor agreement among pain ratings provided by young children, their parents, and healthcare practitioners.
- The findings suggest that current methods may not accurately capture the true pain experience in young children.
- Further research is needed to identify the most appropriate and reliable pain assessment tool for this age group.
Objective:
Visual analog pain scales are reliable measures in older children and adults; however, pain studies that include young children often rely on parental or practitioner assessments for measuring pain severity. The authors correlated patient, parental, and practitioner pain assessments for young children with acute pain.
Methods:
This was a prospective, descriptive study of a convenience sample of 63 emergency department patients aged 4-7 years, with acute pain resulting from acute illness or painful invasive procedures. A trained research assistant administered a structured pain survey containing demographic and historical features to all parents/guardians. Children assessed their pain severity using a validated ordinal scale that uses five different faces with varying degrees of frowning (severe pain) or smiling (no pain). Each face was converted to a numeric value from 0 (no pain) to 4 (severe pain). Parents and practitioners independently assessed their child's pain using a validated 100-mm visual analog scale (VAS) marked "most pain" at the high end. Pairwise correlations between child, parent, and practitioner pain assessments were performed using Spearman's or Pearson's test as appropriate. The association between categorical data was assessed using chi(2) tests.
Results:
Sixty-three children ranging in age from 4 to 7 were included. Mean age (+/-SD) was 5.7 (+/-1.1); 42% were female. Fifty-seven successfully completed the face scale. The distribution of the children's scores was 0-17%, 1-9%, 2-30%, 3-14%, and 4-30%. Mean parental and practitioner scores (+/-SD) on the VAS were 61 (+/-26) mm and 37 (+/-26) mm, respectively (maximal = 100 mm). Correlation between child and parent scores was 0.47 (p < 0.001). Correlation between child and practitioner scores was 0.08 (p = 0.54). Correlation between parent and practitioner scores was 0.04 (p = 0.001).
Conclusions:
There is poor agreement between pain ratings by children, parents, and practitioners. It is unclear which assessment best approximates the true degree of pain the child is experiencing.