Observational pain assessment versus self-report in paediatric triage

Area of Science:

• Pediatric Emergency Medicine
• Pain Assessment
• Clinical Triage

Background:

• Accurate pain assessment is crucial for effective triage in pediatric emergency departments.
• Observational pain assessment tools are used to evaluate pain in children who cannot self-report.

Purpose of the Study:

• To evaluate the utility of observational pain assessment for triage in children over 3 years old.
• To compare observational pain scores with self-reported pain scores in pediatric patients.

Main Methods:

• A prospective, single-blind, controlled trial involving 75 children (aged 3-15 years) presenting to the ED with pain.
• Pain was assessed using the Alder Hey Triage Pain Score (AHTPS) and self-report scales (Wong-Baker Faces Pain Rating Scale or Visual Analogue Scale).
• Scores were compared between observational and self-report methods, and between waiting room and triage room assessments.

Main Results:

• Observational AHTPS scores were significantly lower than self-reported Wong-Baker Faces Pain Rating Scale/Visual Analogue Scale scores (p<0.001).
• Both observational and self-reported pain scores were lower in the triage room compared to the waiting room.
• Self-reported pain scores significantly decreased from waiting room to triage room (p<0.042 for WBS, p<0.006 for VAS).

Conclusions:

• Observational pain assessment underestimates children's perceived pain and is not recommended for children over 3 years old.
• The emergency department triage process appears to have a calming effect on children experiencing pain.