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Pain assessment for pediatric patients in the emergency department
Amy L Drendel1, David C Brousseau, Marc H Gorelick
1Department of Pediatric Emergency Medicine, Children's Hospital, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. adrendel@mail.mcw.edu
Insights
Pain score documentation in pediatric emergency departments is low, especially for infants and toddlers. Documenting pain scores is linked to increased analgesic and opioid use, highlighting a need for better pain management strategies.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Health Informatics
Background:
- Effective pain management in pediatric emergency departments (EDs) is crucial.
- Pain score documentation is a key component of assessing and treating pain in children.
- Current documentation rates and their impact on treatment are not fully understood.
Purpose of the Study:
- To investigate factors associated with pain score documentation in pediatric ED visits.
- To determine if documented pain scores influence analgesic prescription rates.
Main Methods:
- Cross-sectional analysis of pediatric ED visits using the National Hospital Ambulatory Medical Care Survey (1997-2000).
- Survey-weighted regression models assessed associations between visit characteristics and pain score documentation.
- Further regression analyzed the link between pain score documentation and analgesic use, controlling for visit characteristics.
Main Results:
- Only 44.5% of pediatric ED visits included documented pain scores.
- Younger age, self-pay status, pediatric facility visits, and non-injury-related visits were associated with lower documentation rates.
- Documented pain scores significantly increased the likelihood of receiving analgesics, particularly opioids.
Conclusions:
- Pain score documentation in pediatric EDs is inadequate, with infants and toddlers being particularly vulnerable.
- A strong association exists between pain score documentation and the prescription of analgesics, including opioids.
- Improving pain documentation for acutely ill and injured children is essential for optimizing pain management.
Objective:
To examine the relationship between pediatric patient visit characteristics and pain score documentation in the emergency department (ED) and determine whether documentation of a pain score is associated with increased analgesic use.
Methods:
A cross-sectional analysis was conducted of ED visits for pediatric patients from the National Hospital Ambulatory Medical Care Survey (1997-2000). Survey weighted regression first was used to assess the association between patient visit characteristics and pain score documentation. The regression then was repeated to determine the association between documentation of a pain score and analgesic use, adjusting for visit characteristics.
Results:
A total of 24,707 visits were included. Only 44.5% of visits had documented pain scores. In the regression analysis, younger age, self-pay, visits to pediatric facilities, and visits that were not designated as injury related were associated with decreased pain score documentation. Documentation of pain score was associated with increased odds of an analgesic prescription and opioid prescription. When no pain score was documented, the odds of receiving any analgesic was similar to visits with pain documented as mild.
Conclusion:
ED pain score documentation is suboptimal in the pediatric population. Infants and toddlers are at particular risk for not having a pain score documented. There is a significant association between pain score documentation and the use of any analgesic, particularly opioids. Improvements in pain documentation for acutely ill and injured children are needed to improve pain management.
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