title: Pain Assessment in Children Younger Than 8 Years in Out-of-Hospital Emergency Medicine: Reliability and Validity of EVENDOL Score.
abstract: OBJECTIVE
  Pain in children is underestimated and undertreated in out-of-hospital emergency medicine. In this setting, caregivers need a reliable pain scale, but none has been validated. A single observational pain scale for all children younger than 8 years, EVENDOL, has been validated in emergency pediatric units. We study the feasibility of EVENDOL score in an out-of-hospital emergency setting.
  
  
  METHODS
  This prospective multicenter study included all conscious children younger than 8 years transported by a mobile intensive care unit between October 2008 and May 2010. The emergency physician and nurse independently assessed the child's pain using first a numeric rating scale (score 0-10), then the 5-item EVENDOL scale (verbal/vocal expression, facial expression, movements, postures, and relationship with entourage) (score 0-3/item) at 3 time points (at rest, during examination, and after analgesia). We studied the scale's internal validity, interrater reliability, discriminant ability (influence of fever and anxiety), and face validity.
  
  
  RESULTS
  Of the 422 included children, 82 and 62 (29%-39%) were in pain according to the emergency physician and nurses (numeric rating scale >3/10). All EVENDOL scale attributes were satisfied at all 3 time points, for all population subsets. Values for the first assessment (entire study population) were as follows: internal validity (0.78-0.89), interrater reliability (r = 0.63-0.76, weighted κ = 0.49-0.65), construct validity, and discriminant ability (r = 0.6-0.7). Fever did not impact on EVENDOL score. Anxiety level and pain were correlated. Completion time was fast (mean, 2.3-3.4 minutes). Face validity was good.
  
  
  CONCLUSIONS
  EVENDOL is a quick, easy-to-use, discriminant instrument to assess pain in young children in out-of-hospital emergency settings.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Beltramini
authors.forename: Michel
authors.initials: M
authors.lastname: Galinski
authors.affiliation: AP-HP, SMUR Pédiatrique, Groupement Hospitalier Universitaire Sud, Clamart.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Chabernaud
authors.affiliation: Réanimation Polyvalente SMUR, CHI Poissy-St Germain en Laye, Saint Germain en Laye.
authors.forename: Ramon
authors.initials: R
authors.lastname: Ruiz Almenar
authors.affiliation: AP-HP, SMUR Pédiatrique, Hôpital A. Grégoire, Montreuil.
authors.forename: Michael
authors.initials: M
authors.lastname: Tsapis
authors.affiliation: AP-HP, SAMU 92-SMUR Garches, Hôpital R. Poincaré, Garches.
authors.forename: Nathalie Sybille
authors.initials: NS
authors.lastname: Goddet
authors.affiliation: AP-HP, SMUR Pédiatrique, Hôpital R. Debré.
authors.forename: Katia
authors.initials: K
authors.lastname: Kessous
authors.affiliation: AP-HP, Unité INSERM U669, Hôpital Cochin Port-Royal, Paris.
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.affiliation: AP-HP, Centre d'Etude et de Traitement de la Douleur de l'Adulte et de l'Enfant, Groupement Hospitalier Universitaire Sud, Kremlin-Bicêtre, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fournier-Charrière
mesh_terms: D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods; D015203:Reproducibility of Results