Observational pain assessment versus self-report in paediatric triage

Shavit, Itai; Kofman, Mila; Leder, Marc; Hod, T; Kozer, Eran

doi:10.1136/emj.2008.058297

Cited by 43 publications

(27 citation statements)

References 10 publications

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“…4,7,9,12 It can be difficult to recognize and assess a child's pain in the ED. Health care providers often underestimate that pain, [13][14][15] while parents/caregivers (referred to as "caregivers" henceforth) are often considered a valid proxy. 16,17 This reliance on caregiver feedback persists, even when children are able to speak for themselves.…”

Section: Introductionmentioning

confidence: 99%

A Survey of Caregiver Perspectives on Children’s Pain Management in the Emergency Department

Ali

Weingarten

Kircher

et al. 2015

CJEM

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Objectives: We explored caregiver perspectives on their children's pain management in both a pediatric (PED) and general emergency department (GED). Study objectives were to: (1) measure caregiver estimates of children's pain scores and treatment; (2) determine caregiver level of satisfaction; and (3) determine factors associated with caregiver satisfaction. Methods: This prospective survey examined a convenience sample of 97 caregivers (n = 51 PED, n = 46 GED) with children aged <17 years. A paper-based survey was distributed by research assistants, from 2009-2011. Results: Most caregivers were female (n = 77, 79%) and were the child's mother (n = 69, 71%). Children were treated primarily for musculoskeletal pain (n = 41, 42%), headache (n = 16, 16%) and abdominal pain (n = 7, 7%). Using a 100 mm Visual Analog Scale, the maximum mean reported pain score was 75 mm (95% CI: 70-80) and mean score at discharge was 39 mm (95% CI: 32-46). Ninety percent of caregiver respondents were satisfied (80/89, 90%); three (3/50, 6%) were dissatisfied in the PED and six (6/39, 15%) in the GED. Caregivers who rated their child's pain at ED discharge as severe were less likely to be satisfied than those who rated their child's pain as mild or moderate (p = 0.034). Conclusions: Despite continued pain upon discharge, most caregivers report being satisfied with their child's pain management. Caregiver satisfaction is likely multifactorial, and physicians should be careful not to interpret satisfaction as equivalent to adequate provision of analgesia. The relationship between satisfaction and pain merits further exploration. RÉSUMÉObjectifs: L'étude a porté sur le point de vue des aidants quant à la prise en charge de la douleur chez les enfants dans un service des urgences pédiatriques (SUP) et dans un service des urgences générales (SUG). L'étude visait à: 1) mesurer l'intensité de la douleur chez les enfants, estimée par les aidants ainsi que le traitement appliqué; 2) déterminer le degré de satisfaction des aidants; et 3) déterminer les facteurs associés à la satisfaction des aidants. Méthode: Il s'agit d'une enquête prospective, menée dans un échantillon de commodité de 97 aidants (SUP: n = 51; SUG: n = 46) qui accompagnaient des enfants de moins de 17 ans. Des questionnaires d'enquête sur papier ont été distribués par des assistants de recherche, de 2009 à 2011. Résultats: La plupart des aidants étaient des femmes (n = 77; 79 %) et, bien souvent, la mère des enfants (n = 69; 71 %). Les enfants étaient traités surtout pour des douleurs musculosquelettiques (n = 41; 42 %), des céphalées (n = 16; 16 %) et des douleurs abdominales (n = 7; 7 %). Le score maximal moyen, indiqué sur une échelle visuelle analogue de 100 mm s'élevait à 75 mm (IC à 95 %: 70-80) et le score moyen au moment du congé était de 39 mm (IC à 95 %: 32-46). Quatrevingt-dix pour cent des aidants qui ont répondu à l'enquête se sont dits satisfaits (n = 80/89; 90 %); 3 (n = 3/50; 6 %) au SUP et 6 (n = 6/39; 15 %) au SUG ne l'étaient pas. Les aidants qui ont ...

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Section: Introductionmentioning

confidence: 99%

A Survey of Caregiver Perspectives on Children’s Pain Management in the Emergency Department

Ali

Weingarten

Kircher

et al. 2015

CJEM

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“…Furthermore, children with pain can also be quiet and withdrawn, and levels of pain cannot be implied from the presumptive diagnosis. Observational and behavioral pain scales can help objectify pain in pre-verbal children, but it is also important to solicit self-reports of pain in older children who can verbalize their symptoms, because both healthcare providers and parents are known to underestimate the child's pain [8][9][10][11]. To promote pain management, the American Pain Society suggests recording pain scores in the ED as the ''5th vital sign'' [12].…”

Section: Pain Recognition and Assessment In Childrenmentioning

confidence: 99%

Managing Pediatric Pain in the Emergency Department

Bailey

Trottier

2016

Pediatr Drugs

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Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.

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“…Previous studies on pediatric pain assessment in the ED setting have primarily measured acute pain as a chief complaint (Alexander & Manno, 2003;Chisholm et al, 2008;Crocker, Higginbotham, King, Taylor, & Milling, 2011;Fry et al, 1999;Garra et al, 2009;Gourde & Damian, 2012;Johnston et al, 1998;Kelly, Powell, & Williams, 2002;Maciocia et al, 2003;McConahay, Bryson, & Bulloch, 2006;O'Donnell, Ferguson, & Bettie, 2002;Probst et al, 2005;Rajasagaram, Taylor, Braitberg, Pearsell, & Capp, 2009;Russo, 2010;Santervas, et al, 2010;Shavit, Kofman, Leder, Hod, & Kozer, 2009;Strout & Baumann, 2011). The most common method to identify pain assessment practices in the emergency department has been through survey and retrospective chart review (Alexander & Manno, 2003;Jadav, Lloyd, McLauchlan, & Hayes, 2009;Kaplan, Sison, & Platt, 2008;Kleiber, Jennisen, McCarthy, Ansley, 2011;May et al, 2009;Porter & Chapman, 2004;Probst et al, 2005;Santervas et al, 2010;Strout & Baumann, 2011); however, healthcare providers' have been found to report better pain assessment practices on surveys then when compared to actual practice (Read, 1994;Twycross, 2007b;Twycross, 2008).…”

Section: Pediatric Pain Assessment In the Emergency Departmentmentioning

confidence: 99%

“…Results from previous studies show that healthcare provider's perceptions are poor indicators of pain for the pediatric patient in the ED (Maciocia et al, 2003;Rajasagaram et al, 2009;Singer, Gulla, & Thode, 2002;Shavit et al, 2009). Pain is subjective therefore it is important that the patient's perception of their own pain is assessed results of one study where the phenomenological approach was used revealed emergency nurses utilized their observations of behavior to estimate pain in young children (Russo, 2010).…”

Section: Pain Assessment Patient Provider Parentmentioning

confidence: 99%

“…The authors concluded with two recommendations, the CHEOPS and FLACC scales as potential valid measures of procedural pain for clinical practice and research in the ED, and the need for further validation studies of behavioral pain and distress tools for pre or early verbal children undergoing painful procedures in the ED (Crellin et al, 2007). Standard self-report scales have been reported to be reliable and valid for children 3 years and up; however standardized scales have not been designed specifically for the assessment of pain in the ED setting and there is a lack of data on whether those children who can validly use pain scales can be identified beforehand (Besenski, Forsyth, & von Baeyer, 2007;Shavit et al, 2009). …”

Section: Reliability Of Pain Instruments In the Edmentioning

confidence: 99%

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An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

Cummings¹

2013

Journal of Pediatric Health Care

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Rationale for the Study: Despite the exponential growth in pharmacological and nonpharmacological methods for the treatment of pediatric procedural pain there remains a gap between available interventions and actual practice in the emergency department clinical setting. Researchers have recommended the examination of unit culture since culture is proposed to be a major factor that affects the implementation of pain management practices. Method:Ethnography was employed to gain access to the beliefs and practices of healthcare participants in a Northeastern non-pediatric emergency department. Data were collected for 5 months with over 100 hours of observation. Six key informants were interviewed and 44 pediatric procedural interactions with 27 healthcare providers during the treatment of children two to eight years of age undergoing procedures were observed.Other information gathered included documents from the institution, and pain related information from the patient's medical record. All interviews were recorded and transcribed verbatim. Data were managed using the Ethnograph 6.0 and analyzed using the procedure developed by Leininger and McFarland (2006). Results:Seven major themes with categories were discovered that included assessment, ii procedural pain, treatment of pain, communication related to comfort, fragmentation of care in the emergency department, healthcare provider attitudes, and environmental issues and policies. Conclusion:The results of this study suggest that practice environment of the emergency department and organizational culture exerted a significant degree of influence over healthcare providers' pediatric pain management practices. Nurses' did not use pain measurement tools as they were intended to be used and instead improvised measurement by observing the child's behavior. The management of children during painful procedures consisted of an array of behaviors and practices. The use of physical restraint during painful procedures was a common practice. Participants continue to hold many assumptions and misconceptions about pediatric pain assessment and management. The findings of this study provide insight to the everyday practice of emergency department healthcare providers for pediatric pain in a non-pediatric setting.iii Acknowledgments and Dedication

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Observational pain assessment versus self-report in paediatric triage

Abstract: Observational pain assessment underestimates children's perception of pain and should not be recommended in children aged >3 years. Triage has a calming effect on children.

Cited by 43 publications

References 10 publications

A Survey of Caregiver Perspectives on Children’s Pain Management in the Emergency Department

A Survey of Caregiver Perspectives on Children’s Pain Management in the Emergency Department

Managing Pediatric Pain in the Emergency Department

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

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