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A comparison of pain assessment by physicians, parents and children in an outpatient setting
  1. Christina Brudvik1,2,
  2. Svein-Denis Moutte1,3,
  3. Valborg Baste4,
  4. Tone Morken3
  1. 1Bergen Accident and Emergency Department, Bergen, Norway
  2. 2Department of Clinical Medicine, University of Bergen, Bergen, Norway
  3. 3National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
  4. 4Uni Research Health, Bergen, Norway
  1. Correspondence to Dr Christina Brudvik, Bergen Accident and Emergency Department, Solheimsveien 9, Bergen 5008, Norway; christina.brudvik{at}uib.no

Abstract

Introduction Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief.

Patients and methods This cross-sectional study involved 243 children aged 3–15 years treated at Bergen Accident and Emergency Department (ED) in 2011. The child patient's pain intensity was measured using age-adapted scales while parents and physicians did independent numeric rating scale (NRS) assessments.

Results Physicians assessed the child's mean pain to be NRS=3.2 (SD 2.0), parents: NRS=4.8 (SD 2.2) and children: NRS=5.5 (SD 2.4). The overall child–parent agreement was moderate (Cohen's weighted κ=0.55), but low between child–physician (κ=0.12) and parent–physician (κ=0.17). Physicians significantly underestimated pain in all paediatric patients ≥3 years old and in all categories of medical conditions. However, the difference in pain assessment between child and physician was significantly lower for fractures (NRS=1.2; 95% CI 0.5 to 2.0) compared to wounds (NRS=3.4; CI 2.2 to 4.5; p=0.001), infections (NRS=3.1; CI 2.2 to 4.0; p=0.002) and soft tissue injuries (NRS=2.4; CI 1.9 to 2.9; p=0.007). The physicians’ pain assessment improved with increasing levels of pain, but only 42.1% of children with severe pain (NRS≥7) received pain relief.

Conclusions Paediatric pain was significantly underestimated by ED physicians. In the absence of a self-report from the child, parents' evaluation should be listened to. Despite improved pain assessments in children with fractures and when pain was perceived to be severe, it is worrying that barely half of the children with severe pain received analgesics in the ED.

  • clinical assessment
  • emergency department management
  • fractures and dislocations
  • paediatrics, paediatric injury
  • pain management

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/emermed-2016-205825

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    Supplementary materials

    • Abstract in Norwegian

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Contributors S-DM, CB and TM conceived and designed the study. S-DM, CB and TM acquired data. CB, VB, TM and S-DM analysed and interpreted the data. CB drafted the article. VB and TM revised it critically for important intellectual content. CB, VB, S-DM and TM approved the final version to be submitted. CB, S-DM, VB and TM were responsible for the overall content as guarantors.

    • Funding Financial support was provided by the National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway, Norwegian Medical Association's Funds for Research in General Practice, Medicines for Children Network at Haukeland University Hospital, Bergen, and Norwegian Association for Pain in Childhood.

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Ethics approval The Norwegian Ethical Committee for Medical Research.

    • Provenance and peer review Not commissioned; externally peer reviewed.