title: Nationwide study of headache pain in Italy shows that pain assessment is still inadequate in paediatric emergency care.
abstract: OBJECTIVE
  Italian national guidelines on pain management were published in 2010, but there is little information on how effective pain management is in paediatric emergency care, with other countries reporting poor levels. Using headache as an indicator, we described pain assessment in Italian emergency departments and identified predictors of algometric scale use.
  
  
  METHODS
  All Italian paediatric and maternal and child hospitals participated, plus four general hospitals. Data on all children aged 4-14 years admitted during a one-month period with headache as their chief complaint were abstracted from clinical records. Multivariable analyses identified predictors of algometric assessment, taking into account the cluster study design.
  
  
  RESULTS
  We studied 470 admissions. During triage, pain was assessed using a standardised scale (41.5%), informally (15.5%) or was not recorded (42.9%). Only 32.1% of the children received analgesia in the emergency department. The odds ratios for predictors of algometric assessment were non-Italian nationality (3.6), prehospital medication (1.8), admission to a research hospital (7.3) and a more favourable nurses-to-admissions ratio of 10.8 for the highest versus lowest tertile.
  
  
  CONCLUSIONS
  Despite national guidelines, paediatric pain assessment in Italian emergency care was suboptimal. Hospital variables appeared to be stronger predictors of adequate assessment than patient characteristics.
authors.affiliation: Paediatric Department, University Hospital, Padova, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Benini
authors.affiliation: Unit of Epidemiology, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Piga
authors.affiliation: Department of Emergency Medicine, University Hospital, Padova, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Zangardi
authors.affiliation: Department of Emergency Medicine, Burlo Garofolo Children's Hospital, Trieste, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Messi
authors.affiliation: Department of Emergency Medicine, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Tomasello
authors.affiliation: Department of Emergency Medicine, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Pirozzi
authors.affiliation: Research Unit of Perinatal Epidemiology, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006261:Headache / Q000175:diagnosis*; D006769:Hospitals, General / Q000592:standards; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D007558:Italy; D008297:Male; D010147:Pain Measurement / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014218:Triage / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data
keywords: Child; Emergency care; Headache; Pain assessment; Pain management