title: Documented electronic medical record-based pain intensity scores at a tertiary pediatric medical center: a cohort analysis.
abstract: BACKGROUND
  Previous surveys have suggested that pain in hospitalized patients remains undertreated. However, little is known about those with persistently high pain scores.
  
  
  OBJECTIVE
  To document the distribution of scores and analyze the clinical characteristics of outliers with persistently high pain scores.
  
  
  METHODS
  With institutional review board approval, a retrospective cohort analysis of more than 1.5 million documented scores was completed in a tertiary pediatric medical center during a three-year period. Patients with persistently high pain scores were identified for subgroup analysis.
  
  
  RESULTS
  The median score was 0 (all years), and the means were 1.46, 1.34, and 1.3 in 2010, 2011, and 2012, respectively. Approximately 68% of admissions had at least one score of 4 or greater, although this level did not persist. Only 9% had mean scores of 4 or greater, and 1% (n = 492) had mean scores of 7 or greater. Scores remained high in patients within identifiable groups, that is, those with chronic pain (n = 311), sickle cell vaso-occlusive episodes (n = 52), and pain in children with developmental and neuromuscular disorders (n = 32). Few had persistently high scores with acute pain but without known comorbidities (n = 56).
  
  
  CONCLUSIONS
  Detailed review of clinical characteristics of patients with persistently high scores led to the strong impression that, in most cases, persistently high pain was not simply because of inadequate administration of opioids. Instead, the first step in improving pain management of hospitalized children may be the identification of outliers with high pain scores to direct efforts on the development of interventions for patient groups with mechanistically similar pain.
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA. Electronic address: jean.solodiuk@childrens.harvard.edu.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Solodiuk
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Hadley
authors.initials: H
authors.lastname: Brighton
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: McHale
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: LoChiatto
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Deirdre E
authors.initials: DE
authors.lastname: Logan
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Sager
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Berde
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology*; D010147:Pain Measurement / Q000379:methods*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Electronic health records; hospitals; pain; pain management; pain measurement; quality improvement