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Observational Behavioral Coding in the Pediatric Emergency Department: Development of the Emergency Department Child

Sarah R Martin1, Theodore W Heyming2, Brooke J Valdez3

  • 1Department of Anesthesiology and Perioperative Care, University of California, Irvine School of Medicine, Irvine, California; Center on Stress and Health, University of California, Irvine, California; Emergency Medicine, Children's Hospital of Orange County, Orange, California.

The Journal of Emergency Medicine
|May 31, 2024
PubMed

Insights

A new tool, the Emergency Department Child Behavior Coding System (ED-CBCS), reliably measures child distress during emergency department procedures. This validated system aids in assessing interventions for pediatric pain and distress.

Area of Science:

  • Pediatric Emergency Medicine
  • Behavioral Science
  • Clinical Assessment Tools

Background:

  • Children experience significant pain and distress during emergency department (ED) procedures.
  • Existing behavioral assessment tools require validation for pediatric ED settings.
  • Reliable measures are needed to evaluate new interventions for pediatric procedural pain.

Purpose of the Study:

  • To develop and validate the Emergency Department Child Behavior Coding System (ED-CBCS).
  • To assess child distress and nondistress behaviors during pediatric ED procedures.
  • To provide a psychometrically sound tool for use in pediatric EDs.

Main Methods:

  • Iterative development of the ED-CBCS by a multidisciplinary expert panel.
  • Assessment of inter-rater reliability and concurrent validity using video recordings.
  • Inclusion of 38 videos of children (2-12 years) undergoing laceration repair.
  • Utilized Face, Legs, Activity, Cry, Consolability (FLACC) scale for concurrent validity.

Main Results:

  • The final ED-CBCS comprises 27 distinct child distress and nondistress behaviors.
  • Good to excellent inter-rater reliability was achieved (time-unit κ: 0.64–0.98; event alignment κ: 0.62–1.00).
  • ED-CBCS distress and nondistress behaviors showed significant association with FLACC scores, confirming concurrent validity.

Conclusions:

  • The ED-CBCS is a psychometrically sound behavioral assessment tool specifically for pediatric ED procedures.
  • This validated measure can identify behavioral targets for interventions.
  • Future research can utilize the ED-CBCS to evaluate interventions aimed at reducing pediatric procedural pain and distress.
Abstract

Keywords:
behavioremergency departmentmeasurementpainpediatric

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