A comparison of pain assessment by physicians, parents and children in an outpatient setting

C. Brudvik, Svein-Denis Moutte, V. Baste, T. Morken
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引用次数: 69

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.
比较疼痛评估的医生,家长和儿童在门诊设置
我们的目的是比较不同医疗条件下儿童的患者、家长和医生的疼痛评估,并分析这如何影响医生对疼痛缓解的管理。患者与方法本横断面研究纳入2011年在卑尔根急诊科(ED)就诊的243名3-15岁儿童。儿童患者的疼痛强度测量采用年龄适应量表,而家长和医生进行独立的数字评定量表(NRS)评估。结果医生对患儿的平均疼痛评分为NRS=3.2 (SD 2.0),家长评分为NRS=4.8 (SD 2.2),患儿评分为NRS=5.5 (SD 2.4)。总体而言,儿童-父母的一致性是中等的(科恩加权κ=0.55),但儿童-医生(κ=0.12)和父母-医生(κ=0.17)之间的一致性较低。医生明显低估了所有≥3岁儿童患者和所有医疗条件类别的疼痛。然而,对于骨折,儿童和医生在疼痛评估上的差异明显较低(NRS=1.2;95% CI 0.5 ~ 2.0)与伤口相比(NRS=3.4;CI 2.2至4.5;p=0.001),感染(NRS=3.1;CI 2.2至4.0;p=0.002)和软组织损伤(NRS=2.4;CI 1.9 ~ 2.9;p = 0.007)。医生的疼痛评估随着疼痛程度的增加而改善,但只有42.1%的严重疼痛儿童(NRS≥7)获得疼痛缓解。结论急诊科医生明显低估了儿童疼痛。在没有孩子自我报告的情况下,应该听取父母的评价。尽管骨折儿童的疼痛评估有所改善,当疼痛被认为是严重的,但令人担忧的是,只有不到一半的严重疼痛儿童在急诊科接受了镇痛药。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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