Introduction of a paediatric pain management protocol improves assessment and management of pain in children in the emergency department

We have demonstrated the success of a pain scoring system and corresponding analgesia protocol in improving pain management in children attending the emergency department (ED). Pain is often suboptimally managed in children¹ despite evidence that quantification of pain severity is vital to enable provision of appropriate analgesia, and has been shown to reduce time to analgesia in previous studies.² Prior to our audit, no protocol for paediatric pain assessment and management was in use in our ED.

We performed a retrospective assessment of 115 children aged 4–16 years attending the ED with painful conditions such as trauma, abdominal pain, headache and head injury. Only 24% of children received analgesia at initial assessment, with a mean delay of 40 min (SE ±7.55), and no child had a pain score performed. After introduction of a pain scoring chart (adapted from the Wong and Baker face chart³), with a corresponding analgesia protocol, prospective assessment of a further 116 children (similar to the retrospective cohort in terms of age and diagnosis) showed that a pain score was more likely to be performed (71% vs 0%; p<0.001). More children were prescribed analgesia (51% vs 24%, p = 0.001) and the mean delay to prescription was reduced to 15 min (SE ±1.79; p<0.001). When a pain score was performed, the drug choice was appropriate to pain score in 75% of cases, and, of these, when analgesia was given, dosage was appropriate in 93%.

Introduction of this protocol therefore resulted in an increase in formal pain assessment and prescription of appropriate analgesia, and a reduction in time from triage to analgesia. The use of visual pain scoring analogue scales has a particular advantage in ethnically diverse populations such as that served by our ED, where English is a second language for many families, and is affordable and easily achievable. We would recommend introduction of these tools, and training in their use, to all personnel involved in management of paediatric patients with painful conditions. The introduction of such training, alongside appropriate protocols and scoring charts, can ensure that prescription of analgesia remains appropriate for paediatric patients, even within the setting of a general emergency department.

Acknowledgements

We thank Nicola Mayne, Paediatric Pharmacist, University College London Hospital and the Emergency Department staff, University College London Hospital for taking part in this study.