Pediatric Pain Assessment in the Emergency Department

Abstract

Objective This study aimed to assess the agreement between patients presenting to the pediatric emergency department (ED) with acute pain and their caregivers when using the Wong-Baker FACES (WBF) and Faces Pain Scale-Revised (FPS-R). Methods This was a prospective, observational study examining patients 3 to 7.5 years old presenting to a pediatric ED with acute pain. Participants completed the WBF and FPS-R twice during their ED evaluation. Caregivers rated their child's pain using both the WBF and FPS-R at the same time points. Intraclass correlations (ICCs) were calculated between caregiver and child reports at each time point, and Bland-Altman plots were created. Results Forty-six subjects were enrolled over 5 months. Mean age was 5.5 +/- 1.2 years. Average initial child pain scores were 6.6 +/- 2.8 (WBF) and 6.1 +/- 3.3 (FPS-R), and repeat scores were 3.3 +/- 3.4 (WBF) and 3.1 +/- 3.3 (FPS-R). Average initial caregiver pain scores were 6.3 +/- 2.4 (WBF) and 6.2 +/- 2.3 (FPS-R), and repeat scores were 3.4 +/- 2.0 (WBF) and 3.4 +/- 2.1 (FPS-R). On initial assessment, ICCs between children and caregivers using the FPS-R and WBF were 0.33 and 0.22, respectively. On repeat assessment, the ICCs were 0.31 for FPS-R and 0.26 for WBF. Bland-Altman plots showed poor agreement but no systematic bias. Conclusion There was poor agreement between caregivers and children when using the WBF and FPS-R for assessment of acute pain in the ED. Caregiver report should not be used as a substitute for self-report of pain if possible.