title: EVENDOL, a new behavioral pain scale for children ages 0 to 7 years in the emergency department: design and validation.
abstract: Numerous behavioral pain measures have been validated for young children, but none is appropriate to assess pain in emergency departments (EDs), where caregivers need a simple, easily completed scale. Our objective was to elaborate and validate a tool, relevant in any painful situation, with agitation or prostration, and for any age under 7 years. Five items (scored 0 to 3) were developed by pediatric pain and emergency caregivers. The new scale, called EVENDOL, was tested at children's arrival and after analgesics, at rest, and during mobilization. The validation study included 291 children from birth to 7 years old in 4 French EDs, and independent observations by the ED nurse and a researcher. The Cronbach coefficient was excellent (0.83 to 0.92). Construct validity was demonstrated by a decrease in scores after nalbuphine: 8.14 to 3.62 of 15 at rest (P<.0001), 11.87 to 6.65 at mobilization (P = .0011); by good correlations between EVENDOL and nurse or researcher numerical scores: 0.79 to 0.92 (P<.0001); by good correlations between children's self-assessment scores and EVENDOL in children ages 4 to 7 (0.64 to 0.93). Discriminant validity with tiredness, anxiety, and hunger was good. Interrater reliability was excellent between nurses and researcher (weighted kappa 0.7 to 0.9), and in a group of 6 nurses (simultaneous assessment of 122 videos). The treatment threshold was determined at 4 of 15. EVENDOL has excellent validity and can be used for all children under age 7 in EDs, for any age and any pain, acute as well as more prolonged.
authors.affiliation: Pain Unit, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France Pediatric Pain Unit, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France Pediatric Emergency Unit, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France National Center Against Pain, Hôpital Trousseau, Paris, France Pain Unit, Hôpital Saint Jacques, Besançon, France Pediatric Pain Unit, Hôpital Lapeyronie, Montpellier, France Pediatric Emergency Unit, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France Clinical Research Unit, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France INSERM U 669, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fournier-Charrière
authors.forename: Barbara
authors.initials: B
authors.lastname: Tourniaire
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
authors.forename: Patricia
authors.initials: P
authors.lastname: Cimerman
authors.forename: Frédérique
authors.initials: F
authors.lastname: Lassauge
authors.forename: Christine
authors.initials: C
authors.lastname: Ricard
authors.forename: Florence
authors.initials: F
authors.lastname: Reiter
authors.forename: Pascale
authors.initials: P
authors.lastname: Turquin
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Lombart
authors.forename: Alexia
authors.initials: A
authors.lastname: Letierce
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
mesh_terms: D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology*; D010147:Pain Measurement / Q000379:methods* / Q000706:statistics & numerical data; D010808:Physical Examination / Q000379:methods* / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index