To evaluate statewide emergency department assessment and management of pain
in pediatric patients as a quality improvement initiative.
2002 Survey of Illinois Hospital emergency department's pediatric pain
assessment and management strategies, in conjunction with a retrospective chart review of children, ages 0 to 15 years, treated for an extremity fracture. Survey results were available for 123 (59.4%) hospitals; 933 charts (107 hospitals) were reviewed for pain
management. Survey results were compared with practices identified by chart review.
Use of a pain
assessment scale estimated by the survey was 92%, compared with 59% use by chart review. Use of pain
assessment scales for infants was limited. Fifty percent of patients in moderate to severe pain
would be offered an analgesic
. Six- to 15-year-old children would be offered opioids more often than children aged 0 to 1 and 2 to 5 years. Offering higher potency narcotic analgesics was associated with patient's age, geographic location of the facility, and emergency department volume. Providing an analgesic
(odds ratio 4.53, 95% confidence interval 2.89-7.10), offering supportive care (odds ratio 2.37, 95% confidence interval 1.44-3.89), and pediatric-focused annual nurse competencies (odds ratio 1.90, 95% confidence interval 1.18-3.06) correlated with reduction of the patient's pain
Disparity exists between perceived and documented emergency department pain
management practices for children. Quality improvement initiatives should focus on improving pain
assessment in infants, treating moderate to severe pain
in children of all age groups, and education of health care providers in pain
management strategies. Resources should target health care processes effective in decreasing pediatric pain