Association of pain score documentation and analgesic use in a pediatric emergency department

Abstract

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.