Pediatric Pain Assessment in the Emergency Department

Study Overview
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Brief Summary
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To examine pediatric pain assessment in the Emergency Department

Detailed Description
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Phase 1 is a qualitative assessment of how pain is currently evaluated in the pediatric Emergency Department (ED). Initial triage encounters will be observed and audio recorded. In addition to determining how often the Wong Baker FACES Pain Rating Scale (WBF) is administered with the intended script, the investigators will determine if there are common variations from the recommended script. The investigators will also evaluate how often a caregiver's perception of the child's pain is considered when completing the WBF. Phase 2 is a quantitative assessment to determine if neurocognitive development impacts the responsivity of the WBF and the Faces Pain Scale - Revised (FPS-R) as well as the cognitive age equivalent required to use these scales accurately. Patients presenting with acute pain will report their level of pain before and after analgesic intervention using both the WBF and the FPS-R. They will also subjectively report their change in pain following analgesic intervention. Once the patient's pain has improved, he/she will complete the BRIGANCE Early Childhood Screens III to determine his/her cognitive age equivalent. He/she will also complete a series of tasks aimed to assess ability to successfully use the WBF and FPS-R (matching, grouping, classification, and seriation skills). The results of the child's self-report of pain will also be compared to the caregiver's estimate of the child's pain.

Official Title
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Pediatric Pain Assessment in the Emergency Department

Conditions
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Pain, Acute Pain

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: verbal patients pain score ≥ 6/10 caregiver speaks English or Spanish Exclusion Criteria: altered mental status history of traumatic brain injury (TBI) history of developmental delay history of Autism history of chronic pain, defined as persistent or recurrent pain in children with chronic health conditions non-verbal patients

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 7 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Study Population<br>Pediatric patients presenting to the emergency department with acute painful conditions (please see inclusion and exclusion criteria) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Qualitative Assessment (Phase 1 - Primary Aim) | Adherence to a validated script for pain scale administration (dichotomous value - yes/no) | One day | 
| Wong-Baker FACES ® Pain Rating Scale (WBF) | The scale shows a series of faces ranging from a happy face at 0, or no hurt, to a crying face at 10, which represents hurts like the worst pain imaginable. Change in pain scale response before and after analgesic intervention that correlates with a subjective description of change in pain (better or worse). | One day | 
| Faces Pain Scale - Revised (FPS-R) | The scale shows a series of faces ranging from a happy face at 0, or no hurt, to a crying face at 10, which represents hurts like the worst pain imaginable. Change in pain scale response before and after analgesic intervention that correlates with a subjective description of change in pain (better or worse). | One day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Convergent reliability between WBF and FPS-R (Phase 2 Secondary Aim #1) | Convergent reliability between WBF and FPS-R - determined by pre and post analgesia reports of pain using the FPS-R and WBF by the patient. Both scales show a series of faces ranging from a happy face at 0, or no hurt, to a crying face at 10, which represents hurts like the worst pain imaginable. | One day | 
| Pre and Post Analgesia Pain Scores Using WBF and FPS-R as Reported by Patients and Caregivers | Inter-rater reliability between children and caregivers when using WBF and FPS-R, determined by pre and post analgesia reports of pain using the FPS-R and WBF by both the patient and caregiver. Both scales show a series of faces ranging from a happy face at 0, or no hurt, to a crying face at 10, which represents hurts like the worst pain imaginable. | One day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pediatric, children, Faces Pain Scale Revised, Wong Baker FACES, pain scales, BRIGANCE