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Updated: Sep 22, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Factors Associated With Low Procedural Pain Scores Among 1- to 5-Year-Old Patients Undergoing Facial Laceration
Michael Scribner-O'Pray1, Erin Dobie Taylor1, Ernest Krause2
1From the Departments of Emergency Medicine.
Insights
Most young children experience low procedural pain during facial laceration repair. Expert clinicians and avoiding needles reduce distress in pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Child Psychology
Background:
- Facial laceration repair in young children can be a source of significant procedural pain and distress.
- Quantifying pain and identifying factors influencing distress are crucial for improving pediatric care.
Purpose of the Study:
- To quantify pain in young children undergoing facial laceration repair.
- To identify factors associated with low procedural pain scores in this population.
Main Methods:
- Prospective cohort study involving children aged 1-5 years undergoing facial or scalp laceration repair.
- Video recording analysis and pain scoring using the Face, Leg, Activity, Cry, Consolability-Revised (FLACC-r) scale at 15-second intervals.
- Dichotomization of FLACC-r scores (≤3 low, >3 high) to assess practice variables.
Main Results:
- Over 11,000 observations from 258 procedures were analyzed.
- Two-thirds of 3-5 year olds completed repair without restraint, sedation, or anxiolytics.
- Younger children (1-year-olds) experienced significantly more distress than older children.
- Expert clinician involvement (aOR: 1.72) was associated with lower distress, while wound infiltration, needle visibility, and restraint were negatively associated with low pain scores.
Conclusions:
- The majority of 3-5 year olds tolerate facial laceration repair with low distress.
- Minimizing distress may involve expert clinicians, effective local anesthesia, avoiding restraint, and concealing needles.
- These findings can inform strategies to reduce pediatric procedural pain and anxiety.
Objectives:
Our objectives were to quantify pain experienced by young children undergoing facial laceration repair and identify factors associated with low procedural pain scores.
Methods:
We conducted a prospective cohort study of children's distress among a convenience sample of children aged 1 to 5 years undergoing facial or scalp laceration repair in 2 pediatric emergency departments. We reviewed video recordings and documented pain scores at 15-second intervals using the Face, Leg, Activity, Cry, Consolability-Revised (FLACC-r) scale. We dichotomized FLACC-r into low/high scores (≤3 and >3) to evaluate practice variables.
Results:
We included 11,474 FLACC-r observations from 258 procedures in the analysis. Two-thirds of 3- to 5-year-olds completed their laceration repair without the use of restraint, sedation, or anxiolytics. Mean distress scores were low (≤2.5 out of 10) across all procedure phases for 2- to 5-year-old patients. One-year-old patients experienced significantly more distress than their older counterparts (mean ≤4.2 out of 10). Odds of having low FLACC scores (≤3) were greater for patients with an expert clinician (adjusted odds ratio [aOR]: 1.72; 95% confidence interval [CI], 1.05-2.84). Wound infiltration (aOR, 0.35; 95% CI, 0.13-0.93), patient observation of a needle (aOR, 0.21; 95% CI, 0.14-0.33), and restraint (aOR, 0.04; 95% CI, 0.02-0.06) were negatively associated with low FLACC score.
Conclusion:
The majority of 3- to 5-year-old patients were able to undergo facial laceration repair without restraint, sedation, or anxiolytics and with low mean distress scores. Our findings suggest that children's risk of experiencing moderate and severe distress during facial and scalp laceration repair may be reduced by prioritizing wound closure by expert-level clinicians, ensuring effective lidocaine-epinephrine-tetracaine application, avoiding restraint, and concealing needles from patient view.
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