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Association of Pain Score Documentation and Analgesic Use in a Pediatric Emergency Department

Kellogg, Kathryn M. MD, MPH*; Fairbanks, Rollin J. MD, MS†‡§∥; O’Connor, Alec B. MD, MPH; Davis, Colleen O. MD, MPH∥**; Shah, Manish N. MD, MPH∥††‡‡

doi: 10.1097/PEC.0b013e31827687e6
Original Articles

Objectives This study characterizes the association between pain score documentation and analgesic administration among pediatric emergency department patients.

Methods This is a secondary analysis of a prospectively collected research database from an academic emergency department. Records of randomly sampled pediatric patients seen between August 2005 and October 2006 were reviewed. Pain scores from age-appropriate 0 to 10 numeric pain rating scales were abstracted (≥7 considered severe). Descriptive statistics and 95% confidence intervals (CIs) were calculated.

Results An initial pain score was documented in 87.4% of 4514 patients enrolled, 797 (17.7%) with severe pain. Of these, 63.1% (95% CI, 59.7%–66.5%) received an analgesic, and 16.7% (95% CI, 14.2%–19.5%) received it parenterally. Initial pain score documentation was similar across age groups. Patients younger than 2 years with severe pain were less likely to receive analgesics compared with teenaged patients with severe pain (32.1%; 95% CI, 15.9%–52.3%) versus 67.6% (95% CI, 63.2%–71.7%). Of 502 patients with documented severe pain who received analgesic, 23.3% (95% CI, 19.7%–27.3%) had a second pain score documented within 2 hours of the first. Documentation of a second pain score was associated with the use of parenteral analgesic and a second dose of analgesic.

Conclusions In this population, initial pain score documentation was common, but severe pain was frequently untreated, most often in the youngest patients. Documentation of a second pain score was not common but was associated with more aggressive pain management when it occurred. Further study is needed to investigate causation and to explore interventions that increase the likelihood of severe pain being treated.

From the *Department of Emergency Medicine, Vanderbilt University, Nashville TN; †National Center for Human Factors Engineering in Healthcare, MedStar Institute for Innovation; ‡Department of Emergency Medicine, MedStar Washington Hospital Center; §School of Medicine, Georgetown University, Washington, DC; Departments of ∥Emergency Medicine, ¶Medicine, **Pediatrics, ††Community and Preventive Medicine, and ‡‡Division of Geriatrics and Aging, University of Rochester, Rochester, NY.

Disclosure: The authors declare no conflict of interest.

Reprints: Rollin J. Fairbanks, MD, MS, FACEP, National Center for Human Factors Engineering in Healthcare, 3007 Tilden St NW, Suite 7M, Washington DC 10008 (e-mail:

Drs Kellogg and Fairbanks were with the Department of Emergency Medicine, University of Rochester, when the work was performed.

Dr Kellogg was supported by a University of Rochester School of Medicine Research Fellowship Award and by a grant from the Emergency Medicine Patient Safety Foundation. Dr Fairbanks is supported by a NIBIB Career Development Award (1K08EB009090). Dr Shah is supported by the Paul B. Beeson Career Development Award (NIA 1K23AG028942). At the time of the study, Dr O’Connor was supported by The Mayday Fund. The development of the primary database was supported by a grant from the Agency for Healthcare Research and Quality (1U18HS015818) to Dr Fairbanks.

© 2012 Lippincott Williams & Wilkins, Inc.