Documented electronic medical record-based pain intensity scores at a tertiary pediatric medical center: a cohort...

Previous surveys have suggested that pain in hospitalized patients remains undertreated. However, little is known about those with persistently high pain scores.

To document the distribution of scores and analyze the clinical characteristics of outliers with persistently high pain scores.

With institutional review board approval, a retrospective cohort analysis of more than 1.5 million documented scores was completed in a tertiary pediatric medical center during a three-year period. Patients with persistently high pain scores were identified for subgroup analysis.

The median score was 0 (all years), and the means were 1.46, 1.34, and 1.3 in 2010, 2011, and 2012, respectively. Approximately 68% of admissions had at least one score of 4 or greater, although this level did not persist. Only 9% had mean scores of 4 or greater, and 1% (n = 492) had mean scores of 7 or greater. Scores remained high in patients within identifiable groups, that is, those with chronic pain (n = 311), sickle cell vaso-occlusive episodes (n = 52), and pain in children with developmental and neuromuscular disorders (n = 32). Few had persistently high scores with acute pain but without known comorbidities (n = 56).

Detailed review of clinical characteristics of patients with persistently high scores led to the strong impression that, in most cases, persistently high pain was not simply because of inadequate administration of opioids. Instead, the first step in improving pain management of hospitalized children may be the identification of outliers with high pain scores to direct efforts on the development of interventions for patient groups with mechanistically similar pain.