title: A comparison of pain assessment by physicians, parents and children in an outpatient setting.
abstract: BACKGROUND
  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.
  
  
  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.
authors: Bergen Accident and Emergency Department, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors: Christina
authors: C
authors: Brudvik
authors: Bergen Accident and Emergency Department, Bergen, Norway.|National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.
authors: Svein-Denis
authors: SD
authors: Moutte
authors: Uni Research Health, Bergen, Norway.
authors: Valborg
authors: V
authors: Baste
authors: National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.
authors: Tone
authors: T
authors: Morken
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D009664:Norway; D010045:Outpatients / Q000523:psychology; D059408:Pain Management / Q000379:methods / Q000592:standards; D010147:Pain Measurement / Q000592:standards*; D010290:Parents / Q000523:psychology*; D010465:Perception; D010820:Physicians / Q000523:psychology* / Q000592:standards; D057566:Self Report / Q000592:standards*; D011795:Surveys and Questionnaires; D000078329:Workforce
chemical_list: D000700:Analgesics
keywords: clinical assessment; emergency department management; fractures and dislocations; paediatrics, paediatric injury; pain management