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Pain assessment in the paediatric Emergency Department: whose view counts?

Maciocia, Paul M.a; Strachan, Elizabeth M.a; Akram, Ahsan R.a; Hendrie, Rachel E.a; Kelly, Diane N.a; Kemp, Alisona; McLuckie, Alison M.a; Smith, Laura M.a; Beattie, Thomas F.b

European Journal of Emergency Medicine: December 2003 - Volume 10 - Issue 4 - p 264-267
ORIGINAL ARTICLE
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Objectives: To compare patient, guardian and professional assessment of acute pain in children presenting to an Emergency Department, and to examine whether there was a correlation between the scores obtained using the Faces and linear scales for each group.

Methods: A prospective, observational cohort study of 73 children aged 4–14 years attending a paediatric hospital Emergency Department between March and April 2002 with pain caused by an acute injury. The child's pain on admission, as estimated by the child, their guardian and a healthcare professional (nurse/doctor/emergency nurse practitioner) was recorded using a Faces scale and a linear scale.

Results: Professionals consistently score pain lower [median linear scale score 3.1; interquartile range (IQR) 1.6–5.3] than do patients (6.6; 4.9–7.4) or guardians (6.0; 3.9–7.1) using both linear and Faces scales. There is a significant correlation between pain scores obtained using the two scales for professionals [Spearman R value 0.88; 95% confidence interval (CI) 0.82–0.93], guardians (0.83; 0.74–0.89) and patients (0.42; 0.21–0.59).

Conclusion: Professionals score pain lower than do children or guardians. Similar pain scores are obtained using both a Faces and a linear scale. This study offers no support for the introduction of a uniform pain assessment tool in a paediatric Emergency Department setting.

aThe Faculty of Medicine, University of Edinburgh, Edinburgh, UK

bAccident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK

Correspondence to Dr Thomas Beattie, Accident and Emergency Department, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK

Tel: +44 0131 536 0216; fax: +44 0131 536 0052;

e-mail: louise.cowan@luht.scot.nhs.uk

© 2003 Lippincott Williams & Wilkins, Inc.