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Association of pain score documentation and analgesic use in a pediatric emergency department
Kathryn M Kellogg1, Rollin J Fairbanks, Alec B O'Connor
1Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
Insights
Initial pain scores were documented in most pediatric emergency patients, but severe pain often went untreated, especially in young children. Documenting a second pain score was rare but linked to better pain management.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Clinical Documentation
Background:
- Effective pain management in pediatric emergency departments is crucial.
- Understanding the link between pain assessment and treatment is essential for improving care.
- Previous studies highlight variability in pain management practices for children.
Purpose of the Study:
- To analyze the relationship between documented pain scores and the administration of analgesics in pediatric emergency patients.
- To identify factors influencing analgesic administration based on pain severity and patient age.
- To evaluate the impact of follow-up pain assessments on treatment intensity.
Main Methods:
- Secondary analysis of a prospectively collected database from an academic emergency department.
- Review of records for randomly sampled pediatric patients (August 2005 - October 2006).
- Abstraction of pain scores (0-10 scale) and analgesic administration details; descriptive statistics and confidence intervals were calculated.
Main Results:
- Initial pain scores were documented in 87.4% of 4514 patients; 17.7% had severe pain.
- Analgesics were given to 63.1% of patients with severe pain, with 16.7% receiving parenteral administration.
- Younger children (<2 years) with severe pain were less likely to receive analgesics than teenagers.
- Second pain score documentation within 2 hours occurred in 23.3% of treated patients and was associated with parenteral analgesic use.
Conclusions:
- Initial pain score documentation is common in pediatric emergency settings, yet severe pain remains undertreated, particularly in the youngest patients.
- While infrequent, documenting a second pain score correlates with more aggressive pain management strategies.
- Further research is needed to determine causality and develop interventions to ensure adequate treatment for severe pediatric pain.
Objectives:
This study characterizes the association between pain score documentation and analgesic administration among pediatric emergency department patients.
Methods:
This is a secondary analysis of a prospectively collected research database from an academic emergency department. Records of randomly sampled pediatric patients seen between August 2005 and October 2006 were reviewed. Pain scores from age-appropriate 0 to 10 numeric pain rating scales were abstracted (≥ 7 considered severe). Descriptive statistics and 95% confidence intervals (CIs) were calculated.
Results:
An initial pain score was documented in 87.4% of 4514 patients enrolled, 797 (17.7%) with severe pain. Of these, 63.1% (95% CI, 59.7%-66.5%) received an analgesic, and 16.7% (95% CI, 14.2%-19.5%) received it parenterally. Initial pain score documentation was similar across age groups. Patients younger than 2 years with severe pain were less likely to receive analgesics compared with teenaged patients with severe pain (32.1%; 95% CI, 15.9%-52.3%) versus 67.6% (95% CI, 63.2%-71.7%). Of 502 patients with documented severe pain who received analgesic, 23.3% (95% CI, 19.7%-27.3%) had a second pain score documented within 2 hours of the first. Documentation of a second pain score was associated with the use of parenteral analgesic and a second dose of analgesic.
Conclusions:
In this population, initial pain score documentation was common, but severe pain was frequently untreated, most often in the youngest patients. Documentation of a second pain score was not common but was associated with more aggressive pain management when it occurred. Further study is needed to investigate causation and to explore interventions that increase the likelihood of severe pain being treated.
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