Emerg Med J 25:552-555 doi:10.1136/emj.2008.058297
  • Original Article

Observational pain assessment versus self-report in paediatric triage

  1. I Shavit1,
  2. M Kofman1,
  3. M Leder2,
  4. T Hod1,
  5. E Kozer3
  1. 1
    Emergency Department, Meyer Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
  2. 2
    Emergency Department, Children’s Hospital, Columbus, Ohio, USA
  3. 3
    Pediatric Emergency Service, Assaf Harofeh Medical Center, Zerifin, Israel
  1. Dr I Shavit, Emergency Department, Meyer Children’s Hospital, Rambam Health Care Campus, Haifa 31096 Israel; i_shavit{at}
  1. This study was presented at the Fourth European Congress on Emergency Medicine, October 2006.

  • Accepted 7 March 2008


Objective: To examine if observational pain assessment can be used for purposes of triage in children aged >3 years.

Methods: A prospective, single blind, controlled trial was undertaken in children who presented to the emergency department (ED) with pain. Pain was assessed in the waiting room and again at triage before any treatment was administered using the Alder Hey Triage Pain Score (AHTPS), an observational tool designed for triage, and a self-report tool, either the Wong-Baker Faces Pain Rating Scale (WBS) for 3–7-year-old children or a visual analogue scale (VAS) for 8–15-year-old children. Scores were compared by instrument (observational and self-report) and ED location (waiting room and triage room).

Results: 75 children (29 aged 3–7 years and 46 aged 8–15 years) were enrolled in the study. The AHTPS scores were significantly lower than the scores measured by the WBS/VAS (p<0.001). The level of pain measured by both methods (self-report, observational) was lower in the triage room. Compared with the AHTPS, the WBS and VAS scored significantly lower in the triage room than in the waiting room (p<0.042 and p<0.006, respectively).

Conclusions: 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.


  • Funding: None.

  • Competing interests: None.

  • Group authorship: IS conceived the idea for the study and the methodology, assisted in data collection, drafted the manuscript and reviewed the literature. MK collected and analysed the data and conducted the statistical analysis. ML critically reviewed the article and reviewed the literature. TH assisted in data collection. EK critically reviewed the literature, the methodology and the statistics and reviewed the literature.

    IS has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • The study was approved by the institutional ethics committee. Informed consent for participation in the study was obtained from the patients’ caregivers.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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