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Pain Evaluation in the Paediatric Emergency Department: Differences in Ratings by Patients, Parents and Nurses
Beata Rybojad1, Daniel Sieniawski2, Paweł Rybojad3
1Clinic of Anaesthesiology and Paediatric Intensive Care, Medical University of Lublin, 20-093 Lublin, Poland.
Insights
Pediatric patients
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Clinical Assessment
Background:
- Pain assessment in pediatric emergency departments is often inadequate.
- Accurate pain evaluation is crucial for effective treatment.
Purpose of the Study:
- To compare pain severity ratings among pediatric patients, their parents, and triage nurses.
- To assess the concordance of pain evaluation in a pediatric emergency setting.
Main Methods:
- Cross-sectional observational study in a tertiary pediatric emergency department.
- Involved 80 children (6 months-18 years), parents, and nurses.
- Used Numerical Rating Scale for children ≥4 years; FLACC scale for children <4 years.
Main Results:
- Children ≥4 years rated their pain significantly higher than parents and nurses.
- Nurses consistently assigned lower pain scores compared to patients and parents.
- No significant difference in pain scores between parents and nurses for children <4 years.
Conclusions:
- Nurses tend to underestimate pediatric pain compared to patient and parental reports.
- Pain assessment should be performed upon emergency department admission.
- Whenever feasible, patients should self-report their pain severity.
Abstract:
The pain experienced by paediatric patients is rarely evaluated in emergency departments. The aim of the present study was to compare the degree of conformity in patients' pain severity when assessed by themselves (if possible), their parents and a triage nurse trained in pain evaluation.
Methods:
A cross-sectional observational study was conducted at a tertiary paediatric emergency department in Eastern Poland involving children (aged six months to eighteen years), their parents and nurses. The patients had their pain assessed while collecting a medical history. For children ≥ four years of age, the Numerical Rate Scale was used by patients, parents and nurses to evaluate pain. Patients under four years of age were evaluated by parents and nurses using the FLACC scale.
Results:
Eighty patients and their parents were enrolled in the study. For children ≥ four years, patients rated their pain significantly higher than both their parents (p = 0.03) and nurses (p < 0.001), with the latter group producing the lowest scores. For children under four years of age, parental pain assessments did not significantly differ from those of nurses.
Conclusion:
Compared to the patients themselves and their parents, nurses tended to assign lower pain scores for children. Pain should be assessed on admission to the ED and, whenever possible, by the patients themselves.
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