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Observational pain assessment versus self-report in paediatric triage
1Emergency Department, Meyer Children's Hospital, Rambam Health Care Campus, Haifa 31096, Israel. i_shavit@rambam.health.gov.il
Insights
Observational pain assessment tools like the Alder Hey Triage Pain Score (AHTPS) underestimate children's pain perception compared to self-report scales. Triage environments may have a calming effect on pediatric patients.
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.
Objective:
To examine if observational pain assessment can be used for purposes of triage in children aged >3 years.
Methods:
A prospective, single blind, controlled trial was undertaken in children who presented to the emergency department (ED) with pain. Pain was assessed in the waiting room and again at triage before any treatment was administered using the Alder Hey Triage Pain Score (AHTPS), an observational tool designed for triage, and a self-report tool, either the Wong-Baker Faces Pain Rating Scale (WBS) for 3-7-year-old children or a visual analogue scale (VAS) for 8-15-year-old children. Scores were compared by instrument (observational and self-report) and ED location (waiting room and triage room).
Results:
75 children (29 aged 3-7 years and 46 aged 8-15 years) were enrolled in the study. The AHTPS scores were significantly lower than the scores measured by the WBS/VAS (p<0.001). The level of pain measured by both methods (self-report, observational) was lower in the triage room. Compared with the AHTPS, the WBS and VAS scored significantly lower in the triage room than in the waiting room (p<0.042 and p<0.006, respectively).
Conclusions:
Observational pain assessment underestimates children's perception of pain and should not be recommended in children aged >3 years. Triage has a calming effect on children.
