Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. 1511-1518 (doi:10.1542/peds.2005-2046)

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Pain Assessment for Pediatric Patients in the Emergency Department

Amy L. Drendel, DO, MS, David C. Brousseau, MD, MS, Marc H. Gorelick, MD, MSCE

Department of Pediatric Emergency Medicine, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin

OBJECTIVE. To examine the relationship between pediatric patient visit characteristics and pain score documentation in the emergency department (ED) and determine whether documentation of a pain score is associated with increased analgesic use.

METHODS. A cross-sectional analysis was conducted of ED visits for pediatric patients from the National Hospital Ambulatory Medical Care Survey (1997–2000). Survey weighted regression first was used to assess the association between patient visit characteristics and pain score documentation. The regression then was repeated to determine the association between documentation of a pain score and analgesic use, adjusting for visit characteristics.

RESULTS. A total of 24707 visits were included. Only 44.5% of visits had documented pain scores. In the regression analysis, younger age, self-pay, visits to pediatric facilities, and visits that were not designated as injury related were associated with decreased pain score documentation. Documentation of pain score was associated with increased odds of an analgesic prescription and opioid prescription. When no pain score was documented, the odds of receiving any analgesic was similar to visits with pain documented as mild.

CONCLUSION. ED pain score documentation is suboptimal in the pediatric population. Infants and toddlers are at particular risk for not having a pain score documented. There is a significant association between pain score documentation and the use of any analgesic, particularly opioids. Improvements in pain documentation for acutely ill and injured children are needed to improve pain management.

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Key Words: analgesia • pain assessment • emergency department

Abbreviations: ED—emergency department • JCAHO—Joint Commission on Accreditation of Healthcare Organizations • NHAMCS—National Hospital Ambulatory Medical Care Survey • NCHS—National Center for Health Statistics • OR—odds ratio • CI—confidence interval

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Accepted Oct 18, 2005.

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