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Pain Assessment in Pediatric Emergency Departments: A National Survey
Joshua Haupt1, Nipam Shah1, Matthew Fifolt2
1From the Department of Pediatrics, Division of Pediatric Emergency Medicine.
Insights
Pediatric emergency departments (EDs) in the US are routinely assessing pain using age-appropriate scales, contrasting with previous findings. Further research should explore implementation barriers and the impact of pain assessments on pediatric emergency care.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Pain Management
Background:
- Accurate pain assessment is crucial in pediatric emergency settings.
- Data on current pain assessment practices and tool utilization in pediatric emergency departments (EDs) are limited.
- Understanding the status of pain assessment is vital for improving pediatric emergency care.
Purpose of the Study:
- To determine the current status of pain assessment practices in US pediatric EDs.
- To investigate the utilization of age-appropriate pain assessment tools across different pediatric age groups.
- To identify trends in pain assessment protocols within pediatric EDs.
Main Methods:
- A cross-sectional online survey was distributed to pediatric EDs within the Children's Hospital Association.
- Survey responses were analyzed using descriptive statistics, with categorical variables compared using chi-squared tests.
- The survey focused on formal pain assessment protocols, tool usage by age, and nursing responsibilities.
Main Results:
- All surveyed pediatric EDs (100%) perform formal pain assessments, with 63% using ED-specific protocols.
- Freestanding children's hospitals were more likely to have ED-specific protocols than non-freestanding centers (P = 0.04).
- Age-appropriate scales were widely used: Face, Legs, Activity, Cry, Consolability (FLACC) for 0-2 years (54%), and numerical scales for older children (80-100%).
Conclusions:
- US pediatric EDs are consistently assessing pain with age-appropriate tools, contrary to prior research.
- Nurses are universally tasked with pain assessment in these settings.
- Further research is needed to address implementation barriers and the impact of pain assessments on pediatric emergency care.
Objective:
Accurate and consistent assessment of pain is essential in the pediatric emergency setting. Despite recommendations for formal assessment protocols, current data are lacking on pain assessment in pediatric emergency departments (EDs) and, specifically, whether appropriate tools are being used for different age groups. Our aim was to determine the status of pain assessment in US pediatric EDs.
Methods:
We disseminated an online cross-sectional survey (after piloting) to pediatric EDs within the Children's Hospital Association. Responses were analyzed for each question owing to incomplete responders. We report descriptive statistics, with categorical variables compared with χ2 (P < 0.05 considered statistically significant).
Results:
From 120 pediatric EDs, we received 57 responses (48%). Most respondents (28/49, 57%) were from freestanding pediatric centers. All 57 EDs (100%) performed formal pain assessments, with 31 (63%) of 49 using an ED-specific protocol. Freestanding children's hospitals were more likely to have ED-specific protocols (21/31, 68%) than nonfreestanding (10/31, 32%) (P = 0.04). Among 56 responders, 100% stated that nurses are tasked with assessing pain. For children 0 to 2 years, 29 (54%) of 54 used the Face, Legs, Activity, Cry, Consolability scale. Numerical scales were increasingly used with older ages: 3 to 4 years, 40 (80%) of 50; 5 to 10 years, 49 (98%) of 50; and 11 to 21 years, 50 (100%) of 50.
Conclusions:
In contrast to prior research, US pediatric EDs are routinely assessing pain with scales that are mostly appropriate for their respective age groups. Further research is needed to explore barriers to implementing appropriate pain ratings for all children and, ultimately, how these assessments impact the care of children in the emergency setting.
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